Presented by

Kiran Patil

Introduction:

Chandler published the first series of patients with progressive osteomyelitis of the temporal bone and termed the condition malignant otitis externa.

Definition

Invasive infection in external auditory canal and skull base.

Antomy of external auditory canal

Causes and pathophysiology

Risk Factor

Age

Diabetes mellitus

Any condition causing immunosuppression,

Especially elderly patients

Microbiology

The causative agent - Pseudomonas aeruginosa ( a gram-negative – aerobe)

Other bacteria, including Staphylococcus aureus , S epidermidis , Proteus mirabilis , Klebsiella,

fungal organism is Aspergillus fumigatus

Process of disease

Infection from the EAC spreads

Through the fissures of Santorini, small perforations in the cartilaginous portion of the EAC

Infection spreads medially to the tympanomastoid suture, and along venous canals and fascial planes

The compact bone of the skull base becomes replaced with granulation tissue,

Bone destruction

Progressive spread of infection to skull base foramina causes cranial neuropathies(more Fascial)

Spread of infection to the sigmoid sinus can lead to septicthrombosis of the sigmoid sinus and internal jugular vein; meningitis and cerebral abscess may also complicate MOE

Clinical presentationOtalgia –throbbing pain Nocturnal pain and aggravated by chewing

Otorrhea – pus discharge - yellow, yellow-green, foul smelling, persistent

Hearing loss

Fever

Trouble swallowing

Weakness in the face

Voice loss

Physical examination

Otoscope- purulent otorrhea with a swollen, tender external auditory canal are hallmarks.

Granulation tissue or exposed bone is frequently seen on the floor of the canal at the bony–cartilaginous junction.

Diagnosis History and physical examination Laboratory- ESR level, culture swab Radiology and imaging studies CT scan- sensitive in diagnosing abscess formation and involvement of the mastoid, temporomandibular joint, infratemporal fossa, nasopharynx, petrous apex, and carotid canalMRI- MRI better shows changes in soft tissue, particularly dural enhancementand involvement of medullary bone spacesbiopsy – to rule malignanceNuclear imaging- Technetium Tc 99m, scintigraphy (bone scan) , Gallium Ga 67 citrate

Management

Medical Management Long-term antibiotic- for at least 6 to 8 weeks- oral

and intravensous ciprofloxacin (750 mg twice daily) has been proposed as the preferred initial antibiotic regimen

Fluoroquinolones are active against P aeruginosa, ,

Cephalosporins -ceftazidime, provide an alternative to ciprofloxacin in the treatment of MOE

Aminoglycoside

Amphotericin B is the most commonly used antifungal agent for fungal

Hyperbaric oxygen (HBO)-

HBO increases the partial pressure of oxygen, improving hypoxia and allowing greater oxidative killing of bacteria. HBO requires daily treatments for several weeks and side effects include oxygen toxicity, barotrauma, and tympanic membrane perforation

Surgical Management: Surgical excision play no role in the treatment.

Debridement and or biopsy only indicated in rule the cancer.

Complication Damage to the cranial nerves, skull, or brain

Return of infection, even after treatment

Spread of infection to the brain or other parts of the body

Prevention To prevent an external ear infection:

Dry the ear thoroughly after it gets wet.

Avoid swimming in polluted water.

Protect the ear canal with cotton or lamb's wool while applying hair spray or hair dye (if you are prone to getting external ear infections).

After swimming, place 1 or 2 drops of a mixture of 50% alcohol and 50% vinegar in each ear to help dry the ear and prevent infection.

Nursing Management Pain assessment and Management

Fever management

Obtaining the Laboratory Samples especially cultures in aseptic ways.

Medication Administration

Infection Prevention

Diet and Nutrition

Health education

Geriatric Care

Nursing Problem Altered comfort related ear Pain.

Altered Body Temperature related to Infection

Altered hearing perception related to ear discharge

Knowledge deficit related to disease process, nutrition, and management.

Conclusion