Malignant otitis externa: What is the role of surgery?

Objective: Malignant otitis externa (MOE) is typically managed with long-term broad-spectrum antibiotics. The impact of surgical intervention on clinical outcomes is not well described. This study aims to compare clinical outcomes of MOE patients managed with or without surgery.

Study design/setting: Retrospective cohort, academic tertiary referral center.

Methods: Patients diagnosed with MOE between January 2010 to September 2022 were included. Univariate analyses compared symptoms at initial presentation and long-term (≥1 year) outcomes between surgical and non-surgical patients.

Results: A total of 23 patients were included (78% male, mean age 69 ± 13 years, median follow-up 305 days). Most (N = 22, 96%) patients were diabetic. Seventeen (74%) underwent surgical intervention (76% tympanomastoidectomy, 24% external auditory canal debridement and biopsy). Poor facial nerve (FN) function at initial presentation (defined as House-Brackmann [HB] grade ≥3) significantly predicted undergoing surgical intervention (p = 0.02). Comparing surgically managed versus non-surgical patients at the time of presentation, there were no differences in the degree of hearing loss, severity of diabetes, rate of insulin dependence, incidence of immunosuppression, or the Charlson Comorbidity Index (all p > 0.05). FN outcomes at long-term follow-up also did not significantly differ (p > 0.05). No significant differences in the length of stay (9 vs. 6 days, p = 0.2), rate of readmission (31% vs. 17%, p = 0.5) or 5-year overall survival (53% vs. 66%, p = 0.6) were observed between surgical and non-surgical patients.

Conclusions: Long-term outcomes for patients with MOE remain poor. Patients with poor FN function at presentation were more likely to undergo surgical intervention. Patient comorbidities, including the severity of diabetes, were not predictive of undergoing surgery. However, surgical intervention for MOE did not appear to lower the length of stay, the rate of hospital readmission, or overall mortality in our cohort.

Level of evidence: III.