Acyclovir is treatment of choice. Malignant otitis externa is due to Pseudomonas invasion of soft tissue, cartilage, and bone. Treatment includes debridement of infected tissue, decompression of facial nerve when involved, and six weeks of semi-synthetic penicillin in combination with an aminoglycoside. Cipro may have a role in long-term therapy. May result in bony obliteration of foramina with compression of cranial nerves.
Decompression is indicated on rare occasion.
Disorders of the Facial Nerve. W.B. Saunders, Philadelphia, l973. Facial Nerve Surgery , Aesculapius, Birmingham, l977. Year Book Medical Publishers, Chicago, 1990. Management of Traumatic Injuries to the Facial Nerve.