Patient cases with malignant otitis externa at the university clinic of Ludwig Maximilians University Munich from 2009 until 2020

Malignant otitis externa (MOE) is a rare, potentially life-threatening disease. It involves inflammation of the external auditory canal with concomitant osteomyelitis of the temporal bone, usually with evidence of Pseudomonas aeruginosa. The patient population is often immunocompromised, mostly due to inadequately treated type 2 diabetes mellitus or the use of immunosuppressants. Erosion of the temporal bone is common and can lead to complications such as peripheral facial nerve paralysis, meningitis, and/or cochlear and vestibular damage. The treatment of choice is usually several weeks of antibiogram-controlled intravenous antimicrobial therapy and possibly surgical treatment. Furthermore, if available, optimization of antidiabetic therapy is essential. A retrospective, descriptive, single-center study was performed to characterize consecutive real-life patients with MOE at the University Hospital Munich, Ludwig-Maximilians University, Germany. Thirteen patients with MOE were included in this study. Patient data concerning age, sex, comorbidities, pathogen spectrum, radiological imaging, antibiotic and surgical treatment and other variables were analyzed. In this study, we present a detailed description of a cohort of patients with MOE and propose a therapeutic algorithm that focuses on a combination of antibiotic therapy and surgical debridement of the affected tissue.