A VERY SERIOUS CONDITION OF THE EAR

There are a few  dangerous or serious  conditions which affects the ear and adjacent structures. One such condition is MALIGNANT OTITIS EXTERNA. 

WHAT IT IS? 

It is a life threatening infection of outer ear canal and base of the skull caused by some bacteria ( gram negative) rarely by fungus  ( aspergillus) also . Rapid spread of infection from the skin and soft tissues of the external ear canal occurs, and if  not controlled by treatment, it can affect bone and structures in the skull base. 

WHO  ARE AFFECTED ? 

DIABETIC patients mainly if it ( diabetes) is uncontrolled, and also patients with low immunity, or those who have other immunocompromised illness. IN Diabetic patients certain changes occur in the body( will be  posting later) so  they are more prone to this. 

WHAT ARE THE FEATURES ? 

Usually it may start as an infection affecting the skin of outer ear canal, then soft tissues like perichondrium (outer covering of cartilage)  and cartilage. If not treated promptly or if diabetes is not controlled, bone and nerves will be affected. When the bone is affected, abscess ( pockets of pus) are formed which leads to necrosis or destruction of the bones. 

SYMPTOMS AND SIGNS

History of otitis externa ( already posted before) will be there usually, and patient will have severe 👂ear pain and purulent or pus containing ear discharge. ON examining the ear ,  if granulations( red  lesions) are present on the   bony cartilaginous junction of external ear canal, it is an omnious sign. Other symptoms depends on the structures involved, if nerves are affected, paralysis of the muscles innervated or supplied by it occurs. Biopsy from the granulations to be done, to rule out cancer or other malignancy

WHAT CAN  BE DONE ? 

TREAT  the condition with antibiotics or antifungals if  fungal elements are present. 

CONTROL DIABETES

NECROTIC tissues has to be removed. 

IF bones are involved as in skull base osteomyelitis,long term treatment is needed, or it can affect structures inside the skull like covering of the brain, nerves, blood vessels and brain itself. 

Cases I have seen were   either  limited to ear canal or complicated with  diabetes, and few patients were having nerve involvement. 

THOSE WHO HAVE DIABETES OR ANY IMMUNOCOMPROMISED CONDITIONS PLEASE TAKE CARE OF YOUR EARS. DON'T POKE  THE EAR  WITH ANY OBJECT AS A MILD INJURY  CAN LEAD ON TO MALIGNANT OTITIS EXTERNA OR NECROTIZING OTITIS EXTERNA. 

JUST BE AWARE OF THIS CONDITION.