Journal

Reading

ICD 10 : H60.2

By :
Gosa Rina Lubis, S. ked
Lisa, S. ked
Nurfa Erin. Ked
Wella Fadillah, S. Ked

Department of the Ear, Nose, Thoart and Head Neck

Medical School Riau University
General Hospital Arifin Achmad Riau Province
2018
 Inflamation of external audiotory
Malignant otitis externa canal and is commonly caused by
(MOE) pseudomonas aeruginosa

Introduction Report by Toulmouche in 1838 : necrotizing ototis

externa or skull base osteomyelitis
Methods Chandler published a report in 1968 : MOE

Result
The treatment : antibacterial agents to be
decided after culture and sensitivity of
Discussion the ear discharge

Quinolone proved to be an exellent therapeutic agent in

the beginning
Antipeseudomonal cephalosporins or other antimicrobial
agent
Surgery to the biopsy of the granulation tissue
 Design  Retrospective

Introduction
Study Setting Evaluated the demographic profile,
coexisting disabilities, clinical presentations, and
Methods management of MOE

Result
Data Collection The case records of pat ients treated
between 2006 and 2013 for MOE were reviewed from the
Discussion
medical record department of the hospital

Data Analyses  tabulated in a master chart and data

were analyzed
 15 Patients
12 were males and 3 were females
14 were diabetics and one was non-
Introduction diabetic.

Methods
• the age of the patients ranged between 25 and
Result 82 years
• The eldest 82 yo was non diabetic
• The youngest 25 yo with Type 1 Diabetic
Discussion melitus

Diagnosis
• Patients history
• clinical examination
• microbiology of ear discharge
• Radiological examination
Introduction

Methods

Result

Discussion
 • normal limits in 14 patients.
total leukocyte count • Only one patient had an
elevated

Introduction
• Elevated was observed in all
erythrocyte sedimentation
rate the patients
Methods

Result • were raised in the 14 diabetics

Blood sugar levels • were within normal limits in
one patient
Discussion

• All patients had a good renal

Renal function function
Introduction

Methods

Result

Discussion
Introduction

Methods

Result

Discussion
 TREATMENT
Introduction intravenous
antibacterial
medications Topical acetic Microscopic cleaning of
Methods according to acid drops examination the ear canal
the sensitivity
Result test report

Discussion

In patients with granulation in the ear canal

biopsy
 • duration of treatment was 22 days

Introduction
• Facial nerve palsy did not improve in spite of
physiotherapy during the study period
Methods

Result • Two patients had a recurrence of the disease

Discussion • One patient with temporomandibular joint erosion had

longstanding pain even after the completion of treatment

• The other patient had a recurrence of the disease once—

fourmonths after completing treatment.
 • an aggressive form of
MOE external ear infection
Introduction
• MOE was described as
Methods Meltzer, pyocutaneous osteomyelitis
1959 of the temporal bone
Result

• described this condition as

Discussion Toulmouche early as 1838

• who published the first series

Candler of this condition, and named
this condition MOE
 commonly seen in

diabetes mellitus
Introduction
HIV/AIDS
Methods
chemotherapy induced aplasia
Result
Refractory anemia

Discussion chronic leukemia

Lymphoma
splenectomy

renal transplantation
Introduction
The vulnerability of diabetics to MOE
Methods

Result

Discussion small vessel

endarteritis microangiopathy obliteration due
to the disease
 severe otalgia
Introduction
purulent otorrhea
Methods
aural fullness
Result
hearing loss
Discussion
Temporomandibular joint pain, hemifacial pain, headache,
and trismus

Facial nerve palsy

Elevated ESR
Introduction severe
refractory nocturn
otitis al
externa otalgia
Methods

Result presence of
granulation
Purulent tissue in the
Discussion otorrhea external
auditory canal

growth of presence of
Pseudomonas diabetes or
in the culture immunocom
from ear promised
discharge state
 The facial nerve is the most commonly affected cranial
nerve

Introduction

Methods

Result the proximity of the stylomastoid foramen

Discussion

In our series, only one patient had facial nerve palsy

 MOE
Introduction
Staphylococcus
P. aeruginosa
Methods aureus

Result
Proteus Klebsiella
Discussion mirabilis oxytoca

P. cepacia S. epidermidis
 •Fungi are occasionally isolated from MOE
patients.
Introduction

Methods
Fungal otitis externa  is considered when a patient
Result with symptoms and signs of MOE does not respond
to the appropriate treatment for MOE

Discussion
 CT scan is a better tool to evaluate the
Introduction presence of bony erosions

Methods
technetiu is a more sensitive investigation
Result m-99m because it is positive in all cases of
bone scan MOE, but it is not specific to MOE

Discussion
is more useful than Technetium-
gallium 99m in diagnosis and also in
monitoring the response to
67 scan treatment and detecting
recurrence
Introduction
A medical line of treatment
Methods

Result Most of these

patients can be surgery only for the removal
Discussion
managed with of granulation
tissue and for
histopathological
examination
 Treatment of MOE is
mainly medical. Strict
control of diabetes
Introduction mellitus is extremely
important in controlling
Methods the disease progression

Result

Discussion ciprofloxacin penicillin-like

carbenicillin and
cephalosporins like
ceftazidime and
amino glycosides
 We conclude that MOE

Introduction commonly seen in elderly diabetics

Methods Immunosenescence may be the cause of MOE in elderly

people
Result
Pseudomonas is the most common causative
Discussion
organism isolated in this Condition

Most of these patients can be managed with a

medical line of treatment

surgery only for the removal of granulation tissue and

for histopathological examination