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Hyperbaric Oxygen Therapy (HBOT) in the Treatment of Malignant (Necrotizing) Otitis Externa (MOE)

Malignant (necrotizing) otitis externa (MOE) is an infection that attacks the soft tissue of the ear, specifically the external auditory canal (EAC). The disease causes skull base osteomyelitis whenever the infection gets to the adjacent tissues and parts. Patients who are at a higher risk of contracting the condition include the elderly, diabetic, or those with immunity deficiencies. Some of the symptoms of the condition include persistent ear pain (otalgia), inflammation, and tissue granulation at the osteo-cartilaginous junction. The most popular pathogenic agent that causes MOE is Pseudomonas aeruginosa. The condition compromises the immunity capabilities of the body. It also reduces the oxygen supply to the affected tissues. If the tissues are left unattended, damage and death could result. The most common forms of treatment that have been explored in the treatment of the condition include antipseudomonal antibiotics and antifungals. In case the condition is in its severe stages, surgical debridement might result. HBOT was introduced as adjunctive treatment as a result of increased resistance to antibiotics by the causative pathogens.

How HBOT Works

Once oxygen levels in the affected EAC tissues are improved, the pathogens that cause the condition are suppressed, and they finally die away. An increased supply of oxygen to the hypovascular tissues ensures that white blood cells function optimally. Efficient immunity aids in providing smooth healing. Bacteria are eliminated through the provision of a substrate where free oxygen radicals bind and support respiratory bursts. The affected tissues are able to heal quite rapidly as well. As the affected tissue heals, hyperoxia leads to the formation of new capillaries that increase the supply of oxygen and nutrients to the affected tissues. The bones of the ear canal and the base of the skull are able to resume their functions. Increased immunity as a result of HBOT ensures that infections on the outer ear are handled at that point. The quality of life is improved is improved as well. Such symptoms as severe ear pain, headaches, and insomnia are addressed. Also, the exposed bone that is usually visible from the ear canal is restored to its regular position. The face drop on the affected side regains its form as well. Increased tissue oxygenation results in increased effectiveness of other forms of treatment used as well. HBOT reduces the high morbidity and mortality associated with necrotizing otitis externa. It also reduces instances of surgical debridement by making the condition manageable.


Byun, Y. J., Patel, J., Nguyen, S. A., & Lambert, P. R. (2021). Hyperbaric oxygen therapy in malignant OTITIS EXTERNA: A systematic review of the literature. World Journal of Otorhinolaryngology - Head and Neck Surgery, 7(4), 296–302.  

Sabra, R. M., Taha, M. S., Khafagy, A. G., & Elsamny, T. (2015). Value of hyperbaric oxygen therapy in the management of malignant otitis externa patients. The Egyptian Journal of Otolaryngology, 31(3), 143–148.  




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