Current management of malignant external otitis. A systematic review.

Abstract

INTRODUCTION: Malignant external otitis (OEM), or also called necrotizing external otitis, is a life-threatening infection, mainly affecting the external auditory canal, producing osteomyelitis of the temporal bone; extends to the base of the skull and surrounding tissue, causing sepsis; eventually compromising the cranial nerves and generating multisystemic. Objectives: To describe the current management of malignant external otitis. Specific objectives: 1) To determine the etiology of malignant external otitis. 2) To determine the complications of malignant external otitis. METHODS: A systematic review was performed according to the PRISMA 2020 guidelines with a search for scientific articles, with the term malignant external otitis. We recovered 40 articles corresponding to the last 5 years, obtained from databases such as Cochrane, academic Google, Medline, Mendeley, ScientDirect, IntechOpen. The risks of bias in the studies showed systematic differences due to the heterogeneity of the patients and the treatments between the groups. RESULTS: the management of malignant external otitis includes treatment with anti-pseudomonas antibiotics such as fluoroquinolones in combination with a beta-lactam and an antifungal such as amphotericin B, voriconazole, fluconazole, or echinocandin; in addition to treatment with surgical debridement of the ear canal and radical mastoidectomy, to avoid the risk of neurocranial sepsis, obtaining good results. DISCUSSION: Malignant external otitis is a pathology of rare occurrence that affects immune immunocompromised patients, whose morbidity and mortality is high, if not treated properly. Its main causal agents are: pseudomona aeruginosa, staphylococcus aureus, Candida spp, Aspergillus spp and Geotrichum. The importance of this research lies in optimizing care in the patient with OEM, making a timely clinical and imaging diagnosis, to provide an effective therapeutic alternative, based on broad-spectrum antibiotic therapy, antifungal treatment, and surgical treatment, to avoid complications.