Clinical Management of Malignant Otitis Externa and Related Osteomyelitis

Malignant otitis externa represents a severe infection of the external auditory canal that rapidly extends to the skull base, often culminating in osteomyelitis. Predominantly affecting elderly or immunocompromised individuals—especially those with diabetes—this condition demands prompt recognition and aggressive therapy. Clinical management centres on prolonged antimicrobial regimens directed against Pseudomonas aeruginosa, although a growing spectrum of bacterial and fungal pathogens has been recognised. Diagnostic evaluation integrates anatomical imaging, such as high-resolution CT and contrast-enhanced MRI, with functional studies to delineate bone involvement and monitor treatment response. Novel molecular technologies are refining pathogen identification, facilitating earlier targeted therapy. In advanced cases, surgical debridement may be necessary to eradicate necrotic tissue and achieve source control. Careful monitoring of inflammatory markers and multidisciplinary coordination between otolaryngology, infectious diseases and radiology teams underpin favourable outcomes. The extension of infection to the central skull base poses additional challenges, as cranial neuropathies may develop and prognosis worsens. Global trends toward antimicrobial resistance, limited access to advanced imaging in resource-constrained settings and heterogeneous case definitions highlight the need for standardised diagnostic criteria and collaborative research. Emerging diagnostic and treatment strategies promise to streamline management pathways and reduce morbidity and mortality.

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Clinical Management of Malignant Otitis Externa and Related Osteomyelitis publication trend

The graph below shows the total number of articles in clinical management of malignant otitis externa and related osteomyelitis across all publications each year (not limited to Nature Index journals).

Technical terms

Malignant otitis externa: Aggressive infection of the external auditory canal extending to the skull base.

Skull base osteomyelitis: Inflammatory destruction of bone at the skull base secondary to adjacent infection.

Metagenomic next-generation sequencing (mNGS): Unbiased molecular technique for detecting microbial DNA directly from clinical samples.

Necrotising otitis externa: Severe external ear infection characterised by tissue necrosis, synonymous with malignant otitis externa.

99mTc-mononuclear leukocyte scintigraphy: Nuclear imaging method using radiolabelled white blood cells to localise active infection.

References

1. Case Report: The application of metagenomic next generation sequencing in diagnosing fungal malignant external otitis: a report of two cases. Frontiers in Cellular and Infection Microbiology (2023).
2. The Use of 99mTc-Mononuclear Leukocyte Scintigraphy for Necrotizing External Otitis Diagnosis. Diagnostics (2023).
3. The routes of infection spread in central skull-base osteomyelitis and the diagnostic role of CT and MRI scans. BMC Medical Imaging (2019).
4. Systematic review of the diagnosis and management of necrotising otitis externa: Highlighting the need for high‐quality research. Clinical Otolaryngology (2023).