(0968) Treatment of Polymicrobial Refractory Otitis Externa With Culture Directed Mastoid Powder: A Case Series

Introduction: Otitis externa is an infection of the external ear canal that presents with pain, discharge, and itching. The infection is usually bacterial or fungal and can be polymicrobial. Current treatments of otitis externa may involve antibiotic ear drops +/- steroids, oral antibiotics, or antifungal medications. The primary objective of this study is to evaluate the efficacy of culture directed mastoid powder in the treatment of polymicrobial otitis externa, specifically assessing its impact on the resolution of symptoms and eradication of bacterial and fungal pathogens.

Methods: IRB approval was obtained prior to the initiation of this study. We report a case series of 13 patients with polymicrobial refractory otitis externa treated with mastoid powder. The diagnosis was made in an outpatient clinic setting and was based on the history and physical exam as well as culture results.

Results: The patients had an average age of 46 (range 17-70) with 6 males (46.2%). Complete resolution of all clinical signs and symptoms was observed in 9 (69.2%) patients. Patients who did not experience full resolution of symptoms were either lost to follow-up, pursued alternative treatments, or exhibited only a partial response to the powder. The average treatment duration was 3 weeks. Culture results indicated that 4 (30.8%) patients were infected with Staphylococcus aureus, 3 (23.1%) with Pseudomonas aeruginosa, and 3 (23.1%) with a Corynebacterium species. Aspergillus spp. and Candida spp. were the most prevalent fungi identified in 3 (23.1%) of the cultures.

Conclusions: The majority of patients achieved complete resolution of symptoms which suggests that culture directed mastoid powder continues to be a good clinical option in treatment of polymicrobial otitis externa, and may be underutilized in certain clinical settings.