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Pathology of Necrotizing Otitis Externa (Syn: Malignant External Otitis)

 Dr Sampurna Roy MD


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Necrotizing otitis externa , or malignant external otitis, as initially described by Chandler, is a life-threatening Pseudomonas infection of the external auditory canal and skull base, which occurs most commonly in elderly diabetic patients.

Necrotizing (malignant) external otitis is commonly caused by Pseudomonas aeruginosa. 

It is rarely caused by Aspergillus and Klebsiella pneumoniae.  

The disease spreads rapidly, invading surrounding soft tissues, cartilage and bones causing their necrosis and even spreading to the cranial nerves.

The disease can be fatal if treatment is not aggressive and timely, especially if it spreads outside the auditory canal with involvement of the cranial nerves.

Histologically, the epithelium is necrotic or ulcerated with pseudoepitheliomatous hyperplasia and marked mixed inflammatory infiltrate in subcutaneous tissue.


Further reading:

Malignant Otitis Externa: Evolving Pathogens and Implications for Diagnosis and Treatment.

What are the criteria for terminating treatment for necrotizing (malignant) otitis externa?

Complicated necrotizing otitis externa.

Necrotizing (malignant) external otitis

The changing face of malignant (necrotising) external otitis

Malignant Pseudomonas External Otitis

Malignant otitis externa.

Predicting outcome of malignant external otitis.

Malignant external otitis: a case report and review.

Malignant otitis externa in AIDS patients: case report

Fungal Malignant Otitis Externa with Facial Nerve Palsy

Malignant otitis externa in HIV and AIDS

A rare case of bilateral malignant otitis externa

Malignant external otitis in an immunodeficient infant


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Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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