1 3 Eur Arch Otorhinolaryngol DOI 10.1007/s00405-014-2938-1 OTOLOGY Technetium-99m ( 99m Tc)-labelled sulesomab in the management of malignant external otitis: is there any role? Francesco Galletti · Giovanni Cammaroto · Bruno Galletti · Natale Quartuccio · Francesca Di Mauro · Sergio Baldari Received: 16 December 2013 / Accepted: 6 February 2014 © Springer-Verlag Berlin Heidelberg 2014 the external auditory canal, at the bony-cartilaginous junc- tion; (3) facial or lower cranial nerve palsy [5]. Some of these clinical signs may, however, not be present, making MEO difficult to distinguish from other diseases, such as chronic suppurative otitis media. Moreover, it has been noted that groups of elderly diabetic patients, who present with all the characteristics of MEO, may be characterised by the involvement of the external ear without the devel- opment of temporal bone osteomyelitis. These patients are classified as having severe external otitis (SEO) and require treatment for shorter periods of time [6]. In the present scenario of imaging infection and inflam- mation, nuclear medicine has a relevant role in the evalu- ation of patients with MEO. Technetium-99m ( 99m Tc)- labelled sulesomab (LeukoScan ® , Immunomedics Inc., Morris Plains, NJ, USA) is a 99m Tc-radiolabeled Fab prime fragment of a murine monoclonal antibody [7]. 99m Tc-Sule- somab has been designed to bind to the NCA90 surface antigen of circulating neutrophils and leukocytes already present at the site of infection [8, 9]. The usefulness of 99m Tc-Sulesomab scintigraphy has been assessed in sev- eral infectious and inflammatory diseases (soft tissue and peripheral bone infections, inflammatory bowel disease) showing a sensitivity between 80 and 90 % [10–13], but its potential role in the management of patients with MEO has not yet been described in the literature. The aim of our work is to report two cases of patients with MEO, treated and followed up by 99m Tc-Sulesomab imaging. Case reports This study was approved by the Ethical Committee of the University of Messina Institutional Review Board, and all participants gave informed consent. Abstract We report two cases of malignant external otitis (MEO) evaluated with Technetium-99m( 99m Tc)-labelled sule- somab. Two patients affected by MEO are presented, together with a literature review. Both patients were studied with clini- cal examination, ear discharge culture, radiological imaging, blood exams, 99m Tc Sulesomab, and treated with antibiotic therapy. 99m Tc-Sulesomab would appear to be an useful tool for diagnosis and follow-up of MEO, highlighting the site and extension of the inflammatory process, and evaluating course and treatment efficacy. 99m Tc-Sulesomab shows promise as a rapid, effective and safe imaging agent for treatment response evaluation and follow-up of patients with MEO. Further stud- ies are warranted to validate the inclusion of 99m Tc-Suleso- mab scan in the imaging follow-up of patients with MEO. Keywords 99m Tc-sulesomab · Malignant external otitis · Follow-up · Treatment efficacy Introduction Malignant external otitis (MEO) is a rare but severe dis- ease, caused principally by Pseudomonas aeruginosa, which generally affects elderly diabetic patients [1–4]. Typ- ical clinical features of MEO include: (1) otitis, resistant to conventional therapy; (2) granulation tissue in the floor of F. Galletti (*) · G. Cammaroto · B. Galletti Department of Otorhinolaryngology, University of Messina, Messina, Italy e-mail: ent.messina@hotmail.it N. Quartuccio · F. Di Mauro · S. Baldari Nuclear Medicine Unit, Department of Biomedical Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy