Merck Manual

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Malignant External Otitis

(Skull Base Osteomyelitis; Necrotizing Otitis Externa)

By

Bradley W. Kesser

, MD, University of Virginia School of Medicine

Reviewed/Revised Feb 2024
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Malignant external otitis is a dangerous infection of the external ear that has spread to the temporal bone (the skull bone that contains the ear canal), the middle ear, and the inner ear.

Despite the name, the infection is not cancerous (malignant).

Symptoms of Malignant External Otitis

People with malignant external otitis have severe ear pain (often worse at night), a foul-smelling discharge from the ear, pus and debris in the ear canal, and usually decreased hearing. In severe cases, paralysis of nerves in the face and head may occur as the infection spreads along the base of the skull.

Diagnosis of Malignant External Otitis

  • Computed tomography (CT)

  • Culture of discharge

  • Biopsy

The diagnosis of malignant external otitis is based on results of CT. Doctors also do a culture (a sample of the discharge is grown in a laboratory) to identify the microorganisms causing the infection). Often, doctors need to take a small piece of tissue from the ear canal and examine it under a microscope (biopsy) to make sure that the symptoms are not caused by cancer.

Treatment of Malignant External Otitis

  • Antibiotics, typically given by vein (intravenous)

  • Corticosteroids applied to the outer ear

  • Sometimes hyperbaric oxygen therapy

  • Control of diabetes or other conditions that weaken the immune system

  • Repeated cleanings of the ear canal

Typically, malignant external otitis is treated with a 6-week course of antibiotics given by vein. However, people with a mild infection may be treated with high doses of an antibiotic such as ciprofloxacin taken by mouth. People who have extensive bone disease may require antibiotic therapy for a longer period. Ear drops or dressings that contain a combination of ciprofloxacin (an antibiotic) and dexamethasone (a corticosteroid) are also used to treat malignant otitis.

Although surgery is usually not necessary, repeated cleanings and removal of dead skin and inflammatory tissue (debridement) in the ear canal, done in a doctor's office, are necessary until the infection goes away.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Cetraxal , Ciloxan, Cipro, Cipro XR, OTIPRIO, Proquin XR
AK-Dex, Baycadron, Dalalone, Dalalone D.P, Dalalone L.A, Decadron, Decadron-LA, Dexabliss, Dexacort PH Turbinaire, Dexacort Respihaler, DexPak Jr TaperPak, DexPak TaperPak, Dextenza, DEXYCU, DoubleDex, Dxevo, Hemady, HiDex, Maxidex, Ocu-Dex , Ozurdex, ReadySharp Dexamethasone, Simplist Dexamethasone, Solurex, TaperDex, ZCORT, Zema-Pak, ZoDex, ZonaCort 11 Day, ZonaCort 7 Day
NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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