[Malignant or necrotizing otitis externa: experience in 22 cases].

Malignant or progressive necrotizing otitis extrema is an uncommon but severe infectious condition of the external auditory canal. Over a period of four years, we treated 22 patients: 60% had diabetes (1/4 insulin dependent) and 13% were immunodepressed. The causal germ was Pseudomonas aeruginosa in 87% of cases. The pretherapeutic work-up included a computed tomography scan and a technetium scintigraphy to confirm diagnosis and assess extension. Repeated scintigraphies with gallium were used to follow the course under treatment. Medical treatment was used in most cases (16/22) with parenteral antibiotic therapy using a third-generation cephalosporin (ceftazidime or ceftriaxone) and a fluoroquinolone (ciprofloxacin or ofloxacin) and, if there was no contraindication, hyperbaric oxygen. Surgery is not indicated in malignant otitis externa. We had a 95% cure rate with only 10% recurrence. We reviewed the data in the literature on malignant otitis externa and present the important diagnostic, imaging and therapeutic aspects.