Without therapy, chronic otitis media can cause the same intracranial suppurative complications seen in acute otitis media. Patients have pruritus or pain, or both, that may be severe. Crusting, inflammation, and discharge in the canal are typical findings, and pain resulting from movement of the external ear helps distinguish otitis externa from otitis media. Topical therapy with ear drops containing polymyxin B and neomycin produces excellent results, but patients occasionally acquire true cellulitis of the external ear and then require systemic antibiotics and even debridement of infected cartilage. Malignant otitis externa, an infection with P. aeruginosa that progressively invades the cartilage, soft tissue, and skull, is a rare condition that occurs in diabetics.
Neurologic complications can be lethal.
Prolonged, maximal parenteral therapy with combinations of antipseudomonal agents, such as tobramycin and piperacillin, is generally recommended. Monotherapy with intravenous ceftazidime and prolonged therapy with oral ciprofloxacin have been successful. Other antibiotics that may prove useful alone or in combination are aztreonam and imipenem. Aggressive surgical debridement has been a mainstay of treatment but may be required less often in patients who are treated early and aggressively with antibiotics. Mortality is high but has decreased over the past 10 years.