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Michael Cunningham, MD; Victor L. Yu, MD; Joseph Turner, MD; Hugh Curtin, MD

Arch Otolaryngol Head Neck Surg. 1988;114(5):554-556.

Abstract
• An 85-year-old, nondiabetic man is described with necrotizing (malignant) otitis externa. The patient developed facial nerve paralysis in the presence of a progressive cellulitis and chondritis of the external auditory meatus. Destruction of the bony meatus and mastoid and obliteration of normal soft-tissue planes at the skull base were documented by computed tomographic scans. Aspergillus fumigatus was isolated from the external meatus and deep tissue specimens. Fungal invasion of bone and soft tissue was confirmed histopathologically. Pseudomonas aeruginosa was never isolated. This case is unusual from both the standpoint of etiology and host susceptibility in that the patient had no apparent underlying disease. Amphotericin B and rifampin therapy following radical mastoidectomy halted the progression of disease. Finally, this case illustrates the pitfalls of empiric antibacterial therapy for necrotizing otitis externa without cultural confirmation of the etiologic agent.

(Arch Otolaryngol Head Neck Surg 1988;114:554-556)

Author Affiliations
From the Departments of Otolaryngology (Drs Cunningham and Turner), Medicine (Dr Yu), and Radiology (Dr Curtin), University of Pittsburgh School of Medicine.

Footnotes
Accepted for publication Sept 10, 1987.

Reprint requests to University of Pittsburgh School of Medicine, 968 Scaife Hall, Pittsburgh, PA 15261 (Dr Yu).

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