Otitis externa, necrotising

H60.2

DESCRIPTION

Invasive infection of the external auditory canal, which can extend to involve the base of the skull with cranial nerve palsies and the temporomandibular joint. Presents with severe otalgia and otorrhoea, which is unresponsive to topical therapy for otitis externa. Most common pathogen: P. aeruginosa.

Necrotising otitis externa typically occurs in elderly diabetics or other immunocompromised patients.

GENERAL MEASURES

Debridement as indicated.
Insert a dry wick such as a dried sponge, into the canal under direct vision. Remove the wick 2 days later, and replace if necessary.

MEDICINE TREATMENT

LoEIII

  • Ciprofloxacin, oral, 750 mg 12 hourly, and refer.

REFERRAL

  • For surgical debridement of necrotic bone in non-responders.
  • All cases to a centre where CT scan of the affected area can be done to assess the extent of the disease.
  • Cranial nerve palsies.