Malignant otitis externa in upper Egypt : why do not all diabetics have malignant otitis externa ?

Abstract EN

Eighteen diabetic patients with malignant otitis externa were studied and treated in the EN.T department, Assiut University hospitals during the period from March 199S to September 2000.

These were among 1750 patients with external otitis in the clinic at Assiut University hospitals (0.9%).

'This group consisted of seven men and eleven women.

The age ranged between 50and 75 years..

Diabetes was long standing in all patients (>5 years) Diabetes was uncontrolled except in one.

Laboratory investigations in the form of high and low-density lipids.

ESR, creatinine, and blood sugar curves were done to all patients.

Biopsy for histopathological examination was taken from the granulation tissues or aural polyp.

Computerized tomography of the temporal bones and radioisotope bone scan using Technetium 99 MDP was done to all patients in the nuclear medicine unit in Assail University Hospitals The clinical features and presentation are summarized.

The strategy of diagnosis and treatment is discussed.

Surgery - in the form of surgical debridement was done in the following cases: 1.

Involvement of Cranial nerve, including facial nerve palsy.

2 Persistence of discharge and granulation tissues in spite of medical treatment.

3.

Bone involvement clearly demonstrated by ' T because of the difficulty in eradicating osteomyelitis by medical treatment alone.

Diabetics who were susceptible for malignant external otitis are J.

Those with high level of low-density lipids (9oul of I8) (50%).

2.

Those with defective macro-vasculature .3.

Those diabetics with other systemic disorders as elsewhere malignancy , epilepsy, rheumatoid arthritis, in this study three patients had such systemic problems out of 1H(16 6%).

4.

Previous history of otitis media and discharging ears this occurred in three patients nut of 18 (I6.6%f.

Bui the number in too small to withdraw valid conclusion Combination of antibiotic and drugs that improve microcirculation art essential in treatment of malignant otitis externa.

Liporegulating drugs are also valuable in controlling high level of lDL.

ESF is a useful tool to monitor patients with MOE during treatment and in the follow up