Malignant Otitis Externa

Malignant otitis externa (MOE) is a rare, invasive infection of the temporal bone that arises in the external auditory canal. Most cases are due to Pseudomonas and occur in older diabetic patients. Untreated infection can extend to surrounding soft tissues and bones (temporomandibular joint, nasopharynx, petrous apex, skull base). The infection is subacute to chronic in presentation but potentially life-threatening. The correct diagnosis is often missed for weeks to months because the clinician is unfamiliar with the signs and symptoms of MOE. The high mortality rate seen in early series prompted the adjective “malignant,” but recent series have demonstrated that cure is possible in nearly all cases if MOE is diagnosed early and treated appropriately. This chapter reviews the clinical features, diagnostic evaluation, and treatment of MOE.