Clinical features:
(1) severe otalgia
(2) discharge from the ear
(3) swelling of the external ear canal
Organisms associated with the syndrome of malignant external otitis:
(1) Pseudomonas aeruginosa (involved about 27% of patients)
(2) Klebsiella pneumoniae
(3) fungi (typically Aspergillus species)
(4) Proteus mirabilis
(5) methicillin resistant Staphylococcus aureus (MRSA)
(6) other bacteria
Risk factors for the infection:
(1) diabetes mellitus
(2) other comorbid conditions (cirrhosis, head and neck cancer, malignant lymphoma)
Risk factors for mortality:
(1) osteomyelitis of the skull base, especially if diagnosis and therapy are delayed
(2) palsy involving multiple cranial nerves (indicates more extensive disease)
(3) extension of the infection intracranially
Facial nerve palsy was the most common form of cranial nerve involvement, but Cranial Nerves IX, X, XI and/or XII may be involved.
