Comparative Analysis of Malignant Otitis Externa in the Pre- and Post-coronavirus Disease 2019 Periods: A 9-Year Retrospective Study

Background: Malignant otitis externa (MOE) is a severe, life-threatening infection of the external auditory canal and skull base, predominantly affecting elderly diabetic and immunocompromised individuals. Following the coronavirus disease 2019 (COVID-19) pandemic, an increased incidence and severity of MOE have been reported. This study compares the microbiological profile, clinical presentation, and outcomes of MOE in the pre- and post-COVID-19 periods. Methodology: A retrospective analysis was conducted on patients treated for MOE at a tertiary care center between January 2016 and December 2024. Data regarding demographics, comorbidities, microbiological profile, imaging findings, complications, and treatment outcomes were collected and analyzed. Results: Fifty-six patients were included – 14 pre-COVID-19 and 42 post-COVID-19. Mean ages were 67 and 61 years, respectively. Diabetes mellitus was the most common comorbidity (96%). Pseudomonas aeruginosa was the predominant bacterial isolate (4 pre-COVID-19, 23 post-COVID-19), whereas Candida albicans was the most frequent fungal pathogen (5 post-COVID-19). Facial nerve palsy was the most common complication (1 pre-COVID-19, 13 post-COVID-19). Most patients (77%) received intravenous antibiotics; 17% of post-COVID-19 patients required surgery. Overall mortality was 7%, all in the post-COVID-19 group. Conclusion: A notable increase in aggressive MOE cases occurred post-COVID-19, primarily among diabetic individuals. Early diagnosis, stringent glycemic control, and prompt surgical intervention in extensive disease improve outcomes alongside prolonged antimicrobial therapy.