The Role of Surgical Debridement in Cases of Refractory Malignant Otitis Externa

Abstract

Malignant Otitis externa is a necrotizing condition of external ear involving causing the osteomyelitis of the bone and surrounding soft tissue leading to multiple cranial nerve palsies. Though most patients respond to oral ciprofloxacin but due to emerging resistance cases of refractory malignant otitis externa which are unresponsive to antibiotic therapy for at least 6 weeks are being encountered lately. A study of 20 patients of refractory malignant otitis Externa was conducted at a tertiary care centre in north India; 10 patients were randomly allotted in group A and group B each. Group A was subjected to i/v ceftazidine 1 gm bd with oral ciprofloxacin 750 mg bd and Group B was subjected to surgical debridement with oral ciprofloxacin 750 mg bd. The improvement in symptoms was tabulated and statistical analysis was done using Mann–Whitney U test. There was better resolution of nocturnal pain in patients of group B who underwent surgical debridement although existing facial palsy didn't improve in both the groups. The improvement of symptoms in group B was statistically significant with P ≤ 0.05. We strongly recommend the role of surgical debridement in cases of refractory malignant otitis externa to relieve the patient of nocturnal pain. As the sample size of the study is small we are looking forward to the compilation of a multi institutional data so that a consensus on definitive protocol in cases unresponsive to oral multidrug therapy can be established.

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