What are the otologic manifestations of P aeruginosa infection?

Updated: Dec 17, 2018
  • Author: Selina SP Chen, MD, MPH; Chief Editor: Russell W Steele, MD  more...
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Ear infections (eg, otitis media, chronic suppurative otitis media, otitis externa, malignant external otitis)

  • Involvement of the ear can present as a mild, superficial, and often self-limited infection (eg, swimmer ear) or as malignant otitis externa. Early stages of swimmer's ear are characterized by erythema, edema, accumulation of debris in the canal, and, sometimes, pain. As the disease progresses, the erythema radiates into the pinna, and purulent material partly obstructs the ear, exuding from the canal.

  • More than 95% of cases of malignant external otitis are caused by P aeruginosa. Clinical presentation starts with a history of nonresolving otitis externa, especially in patients who have diabetes or AIDS. Patients present with severe ear pain (otalgia) that worsens at night and a purulent discharge (otorrhea). The pinna may be involved. As the disease progresses, osteomyelitis of the base of the skull and temporomandibular joint osteomyelitis can occur.

  • Children with malignant external otitis have a higher incidence of facial palsy because of underdevelopment of their mastoid process and because of the more medial location of the fissures of Santorini, placing the facial nerve closer to the ear canal. The glossopharyngeal, vagal, spinal accessory, and hypoglossal nerves can be involved. The trigeminal and abducens nerves are rarely affected, and optic nerve involvement has been reported. Involvement of the olfactory, oculomotor, and trochlear nerves has not been reported.

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