A 40 year old woman with a history of type 1 diabetes presents to the clinic for left ear pain and fullness. She also complains of decrease of hearing on the affected side. The patient didn’t measure her blood sugar for 6 months although she has glucometer at home. Her temperature is 99.8 F. Examination reveals tenderness and erythema of the left targus extending to the left side of the face. It also reveals edema of the left external auditory meatus with inflammatory debris. The tympanic membrane appears intact and mobile. Her blood glucose is 340 mg/dL.
What is the most appropriate next step in management?
A- Antibiotic ear drops and follow up in three days
B- Empiric oral antibiotic therapy and follow up in one week
C- Hospitalization for intravenous antibiotics and control of diabetes
D- Initiation of left myringotomy and induction of topical treatment
Answer:
This patient presents with the classic signs and symptoms of extensive otitis externa. There is an evidence of tendency to progress to facial cellulitis. In cases of diabetic and immunocompromised patients, aggressive interaction should be done. Hospitalization and intravenous antibiotics are the appropriate next step of action in this case. Antibiotics ear drops is only used if the patient is not diabetic. Initiation of left myringotomy is not used in otitis externa.
The correct answer is C