Malignant external otitis - Treatment

Malignant external otitis treatment includes correction of immunosuppression, local treatment of auditory canal, long-term antibiotic therapy and surgery in some patients. Strict control of diabetes is mandatory, although it may be difficult to perform in the acute disease. Other statuses and immunosuppressive comorbid conditions also must be controlled.
Local treatment of ear canal includes thorough cleaning and debridement plus topical application of antimicrobial agents.Seizures and other necrotic tissue should be removed. Initial treatment may include application of antimicrobial creams impregnated channel. Antipseudomonas agent should be used first and if necessary it can be changed depending on culture results.
Like other infections involving bone in long-term administration of systemic antibiotics is elective. Antibiotics are effective against Pseudomonas aeruginosa include aminoglycosides, especially penicillins piperacillin tazobactam, ceftazidim, and occasionally cefepim imipenem. Depending on bacterial sensitivity may need a combination of agents. A common combination is a antipseudomonala penicillin and an aminoglycoside.
Checking the response to treatment can be difficult. That is determining the optimal timing for cessation of treatment is problematic. Treatment should continue for at least four weeks but the duration of therapy should be individualized according to clinical presentation, erythrocyte sedimentation rate and imaging studies.
Hyperbaric oxygen, additional antibiotic therapy is considered to increase its capacity to feed polimorfonuclearelor by pathogens.Yet the complexity of administration limits the use of this therapy.
Surgery has a defined but limited role in the treatment of skull base osteitis. Although seizures bone and abscesses are treated surgically, the extent of surgery is counterproductive because it may expose healthy bone to infection.