Malignant Otitis Externa: Clinical Management, Comprehensive Review, and Long-Term Outcomes

Background: Malignant otitis externa (MOE) is a severe, life-threatening infection that primarily affects elderly and immunocompromised individuals, particularly those with diabetes mellitus. This study provides a comprehensive analysis of clinical features, diagnostic methods, management strategies, and long-term outcomes of MOE patients at a tertiary care center. Methods: The retrospective study included 31 adult patients diagnosed with MOE between 2009 and 2020. Data on demographics, comorbidities, symptoms, examination findings, laboratory parameters, imaging, microbiological cultures, treatments, and surgeries were systematically analyzed. Patients with incomplete follow-up or data were excluded. Results: The mean age was 69.5 ± 10.9 years, with 64.5% male predominance. Diabetes was the most common comorbidity (96.8%), followed by hematological malignancies, chronic renal failure, and hypertension. Persistent otalgia (100%) and otorrhea (93.5%) were the leading symptoms. Physical exams revealed granulation tissue (70.9%), canal edema (77.4%), and exposed bone tissue (6.5%). Facial nerve palsy occurred in 48.4% of cases, with other cranial nerve involvement in 9.7%. Microbiological cultures predominantly identified Pseudomonas aeruginosa (58.1%), Staphylococcus aureus, and fungal pathogens, with 16.1% culture-negative cases. Imaging, especially technetium and gallium scintigraphy, aided diagnosis and monitoring. All patients received culture-directed antibiotics, with a mean hospitalization of 45.06 ± 19.27 days. Surgical interventions were needed in 48.4% of patients, primarily for advanced disease or treatment failure. Post-treatment, hemoglobin A1c levels decreased from 7.50 ± 1.21 to 6.26 ± 0.72, and erythrocyte sedimentation rate values improved significantly. The mean follow-up was 66.29 ± 48.14 months, with no in-hospital mortality. Conclusion: Malignant otitis externa presents diagnostic and therapeutic challenges, especially in high-risk groups. Early detection, advanced imaging, and a multidisciplinary approach are vital for effective management. Surgical intervention is a crucial option for refractory cases. It is believed that the data from this study will contribute to guidelines that will be developed to improve diagnostic criteria, establish standard treatment protocols, and improve patient outcomes. Cite this article as: S.nmez S, Kara H, Benli A, et al. Malignant otitis externa: clinical management, comprehensive review, and long-term outcomes. B-ENT. 2025;21(2):91-96.