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Malignant Otitis Externa

What is malignant otitis externa?

Otitis externa is a common ear infection also known as swimmer’s ear. It develops in the ear canal leading to the eardrum. In some cases, otitis externa can spread to surrounding tissue, including the bones of the jaw and face. This infection is known as malignant otitis externa.

Although otitis externa is also known as swimmer’s ear, malignant otitis externa isn’t due to water remaining in the ear canal.

Bacteria such as Pseudomonas aeruginosa and Staphylococcus aureus often cause malignant otitis externa. Over 90 percent of people who develop malignant otitis externa have diabetes.

Malignant otitis externa is an aggressive infection rather than a malignancy, or cancer. An alternative name for malignant otitis externa is necrotizing external otitis. If it’s not treated malignant otitis externa can be life-threatening.

What causes malignant otitis externa?

Malignant otitis externa isn’t commonly a complication of swimmer’s ear. Typically, the condition occurs when you have other health problems or you’re receiving treatment that can weaken your immune system. These can include:

If you have a compromised immune system and aggressive bacteria enter your ear canal, your body will have difficulty warding off infection. If the bacteria cause an infection, the infection can damage the tissue of your ear canal and the bones at the base of your skull. If it’s left untreated, the infection can spread to your brain, cranial nerves, and other parts of your body.

What are the symptoms of malignant otitis externa?

The symptoms of malignant otitis externa are easily recognizable. They can include:

If any of these symptoms develop, contact your doctor immediately. Early treatment will help stop the spread of the infection. This will reduce other health complications that result from the infection.

How is malignant otitis externa diagnosed?

Your doctor will perform a physical exam to determine if you have malignant otitis externa. The exam will include a complete health history. This will allow your doctor to identify underlying conditions that may compromise your immune system.

During the exam, your doctor will look into your ear to see if there’s an infection. Your doctor will also examine your head and behind your ear. If there’s drainage from the ear, your doctor may take a sample, or culture, of the drainage. They’ll send this sample to a lab for analysis. This will help identify the bacteria causing the infection.

If you have malignant otitis externa, your doctor may perform additional tests to see if the infection has spread. Such tests include:

How is malignant otitis externa treated?


Treatment for malignant otitis externa typically involves antibiotic therapy. The condition can be difficult to treat. You may need to take antibiotics for several months. You may need to receive the antibiotics intravenously, or through a vein in your arm if your condition is severe. You must continue treatment until tests show that the infection is gone.


You may need surgery if significant tissue damage occurs as a result of the infection. Surgery can remove damaged tissue. Surgery occurs after the infection has been cured. Your doctor will tell you if you need surgery.

How can I prevent malignant otitis externa?

The best thing you can do to prevent malignant otitis externa is to treat all swimmer’s ear infections until they’re gone. This means following your doctor’s advice and finishing the complete dose of your antibiotics.

In addition, if you have a compromised immune system, you should take steps to protect your health. If you have diabetes, this means controlling blood sugar levels. If you have HIV, this means adhering to medications to control the replication of the virus in your body. Protecting your health is important for boosting your immune system and preventing the onset of an infection.

What is the long-term outlook?

If you have a compromised immune system, the infection may return. Recurrent infections can cause damage to the cranial nerves and brain. Spread of the infection to the brain is rare, but it may result in permanent injury and even death. Follow your doctor’s instructions to help prevent recurrent infections.

Content licensed from:

Written by: Darla Burke
Medically reviewed on: May 03, 2017: University of Illinois-Chicago, College of Medicine

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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