Malignant otitis externa: experience with hyperbaric oxygen therapy.

Introduction: The treatment of malignant otitis externa (MOE) with hyperbaric oxygen therapy (HBOT) remains controversial. The rarity of MOE, combined with poor access to hyperbaric facilities, explains the paucity of existing data.
Methods: We retrospectively reviewed all patients with a diagnosis of MOE referred to the Prince of Wales Hospital hyperbaric unit over a period of six years, and report one of the largest case series to date.
Results: From August 2001 to October 2007, 17 patients with MOE were referred, of whom 15 (88%) completed therapy, one did not tolerate HBOT and one was withdrawn due to pulmonary complications. Length of admission averaged 48 days (range 8-93 days) and three received outpatient care. Five patients had complications attributable to HBOT: acute pulmonary oedema (n = 2), seizure (n = 1), tympanic membrane perforation (n = 1) and claustrophobia (n = 1). Average time to follow up was 47 months (range 1-94 months). Twelve patients (70%) were considered cured of their disease, being disease-free at follow up, including four patients who had died of other causes but were symptom-free at the time of death. Three patients died directly from MOE (18%), one after a recurrence of their disease. Two further patients had recurrent disease, both successfully treated with a second cycle of HBOT and antibiotics. Nine patients (53%) had facial nerve palsy before commencement of HBOT, of whom four died, three from MOE, four had ongoing facial paralysis, and one resolved.
Conclusions: HBOT confers minimal morbidity, but its role in MOE remains uncertain. The high mortality of MOE despite maximal therapeutic intervention highlights the need for more effective treatment protocols.