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Byun YJ, Patel J, Nguyen SA, Lambert PR. Hyperbaric oxygen therapy in malignant otitis externa: A systematic review of the literature. World J Otorhinolaryngol Head Neck Surg 2021; 7:296-302. [PMID: 34632343 PMCID: PMC8486695 DOI: 10.1016/j.wjorl.2020.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 03/09/2020] [Accepted: 04/13/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To review the role of adjuvant hyperbaric oxygen therapy (HBOT) in the treatment of malignant otitis externa (MOE). DATA SOURCES PubMed, Scopus, Web of Science, Science Direct, and Cochrane Library were searched for the following concepts: "hyperbaric oxygen" and "malignant or necrotizing otitis externa." METHODS Studies were included if they contained (1) patients with reported evidence of MOE, (2) employment of adjuvant HBOT, (3) details on patients' medical condition, and (4) documented survival outcomes. Extracted information included patient demographics, underlying medical conditions, infectious etiology, signs and symptoms, medical and surgical treatments, duration of medical treatment, mean follow up time, HBOT setting, number of HBOT sessions, complications, survival rate, and all-cause mortality. RESULTS A total of 16 studies comprising 58 patients (mean age 68.0 years) were included. Diabetes was present in 94.7% of cases and Pseudomonas spp (64.3%) was the most common infectious agent. Cranial nerve VII was involved in 55.2% of cases. Overall, the disease cure rate with adjuvant HBOT was 91.4% and all-cause mortality was 8.6%. Among those who had cranial nerve VII involvement, 72.0% had return of function and 93.8% of them survived. CONCLUSION HBOT may be an effective treatment option for refractory or advanced MOE but its efficacy remains unproven due to lack of strong scientific evidence. However, its therapeutic value should not be underestimated given good results and few adverse events reported in this study.
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Affiliation(s)
- Young Jae Byun
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Jaimin Patel
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A. Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Paul R. Lambert
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Koleri J, Al Bishawi A, Al-Sheikh I, Qureshi S, AlMaslamani M, Abdelhadi H. Beware of covert enemies: Candida orthopsilosis malignant otitis externa with base of the skull osteomyelitis, a case report and review of literature. IDCases 2021; 25:e01163. [PMID: 34094863 PMCID: PMC8164024 DOI: 10.1016/j.idcr.2021.e01163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/25/2021] [Accepted: 05/16/2021] [Indexed: 11/27/2022] Open
Abstract
Background Malignant otitis externa (MOE) is a serious infection of the external auditory canal that is frequently associated with skull base osteomyelitis (SBO) as well as secondary neurological sequelae. Patients with poorly controlled diabetes mellitus or immunosuppression are at increased risk of developing such critical infection for multiple local and systemic factors. While most cases are secondary to bacterial infections particularlyPseudomonas aeruginosa, fungal infections are also occasionally encountered, often associated with delayed diagnosis and high morbidity and mortality. Case report We report a case of a 63 years old man with uncontrolled diabetes mellitus who presented with symptoms and signs of MOE, supported by radiological assessments. The patient was treated presumptively with a prolonged course of antibiotics without clinical improvement, coupled with progression of radiological findings and significant disease extension. Reassessment with biopsies and tissue cultures from external auditory meatus, tempo-mandibular bone, as well as base of the skull grew Candida orthopsilosis. The patient received induction treatment with high dose liposomal amphotericin followed by fluconazole to control disease progression and complications. Conclusion Candida MOE with secondary skull base osteomyelitis is rare and difficult to diagnose with no clear guidance on assessment and management. Clinicians should be aware of the unusual presentations where microbiological and histopathological evaluations are essential for proper management.
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Affiliation(s)
- Junais Koleri
- Department of Infectious Diseases, Communicable Diseases Centre, Hamad Medical Corporation, Qatar
| | - Ahmad Al Bishawi
- Department of Infectious Diseases, Communicable Diseases Centre, Hamad Medical Corporation, Qatar
| | - Israa' Al-Sheikh
- Department of Internal Medicine, Hamad Medical Corporation, Qatar
| | - Salman Qureshi
- Department of Neuroradiology, Hamad Medical Corporation, Qatar
| | - Muna AlMaslamani
- Department of Infectious Diseases, Communicable Diseases Centre, Hamad Medical Corporation, Qatar
| | - Hamad Abdelhadi
- Department of Infectious Diseases, Communicable Diseases Centre, Hamad Medical Corporation, Qatar
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Chaudhary HA, Ibrahim WH, Yousaf Z, Abubeker IY, Kartha A. Fungal Malignant Otitis Externa Involves a Cascade of Complications Culminating in Pseudoaneurysm of Internal Maxillary Artery: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:562-566. [PMID: 31005959 PMCID: PMC6489412 DOI: 10.12659/ajcr.913469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Male, 66 Final Diagnosis: Pseudoaneurysm of internal maxillary artery secondary to fungal malignant otitis externa Symptoms: Epistaxis Medication: — Clinical Procedure: Functional endoscopic sinus surgery, endovascular embolization Specialty: Infectious Diseases
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Affiliation(s)
| | - Wanis H Ibrahim
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zohaib Yousaf
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Anand Kartha
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Mortazavi MM, Khan MA, Quadri SA, Suriya SS, Fahimdanesh KM, Fard SA, Hassanzadeh T, Taqi MA, Grossman H, Tubbs RS. Cranial Osteomyelitis: A Comprehensive Review of Modern Therapies. World Neurosurg 2018; 111:142-153. [DOI: 10.1016/j.wneu.2017.12.066] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/07/2017] [Accepted: 12/09/2017] [Indexed: 11/28/2022]
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Khan MA, Quadri SAQ, Kazmi AS, Kwatra V, Ramachandran A, Gustin A, Farooqui M, Suriya SS, Zafar A. A Comprehensive Review of Skull Base Osteomyelitis: Diagnostic and Therapeutic Challenges among Various Presentations. Asian J Neurosurg 2018; 13:959-970. [PMID: 30459850 PMCID: PMC6208218 DOI: 10.4103/ajns.ajns_90_17] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Skull base osteomyelitis (SBO) is a complex and fatal clinical entity that is often misdiagnosed for malignancy. SBO is commonly a direct complication of otogenic, sinogenic, odontogenic, and rhinogenic infections and can present as central, atypical, or pediatric clival SBO. This review describes the clinical profile, investigational approach, and management techniques for these variants. A comprehensive literature review was performed in PubMed, MEDLINE, Research Gate, EMBASE, Wiley Online Library, and various Neurosurgical and Neurology journals with the keywords including: SBO, central or atypical SBO, fungal osteomyelitis, malignant otitis externa, temporal bone osteomyelitis, and clival osteomyelitis. Each manuscript's reference list was reviewed for potentially relevant articles. The search yielded a total of 153 articles. It was found that with early and aggressive culture guided long-term intravenous broad-spectrum antibiotic therapy decreases post-infection complications. In cases of widespread soft tissue involvement, an early aggressive surgical removal of infectious sequestra with preferentially Hyperbaric Oxygen (HBO) therapy is associated with better prognosis of disease, less neurologic sequelae and mortality rate. Complete resolution of the SBO cases may take several months. Since early treatment can improve mortality rates, it is paramount that the reporting radiologists and treating clinicians are aware of the cardinal diagnostic signs to improve clinical outcomes of the disease. It will decrease delayed diagnosis and under treatment of the condition. However, due to rarity of the condition, complete prognostic factors have not fully been analyzed and discussed in the literature.
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Affiliation(s)
- Muhammad Adnan Khan
- Department of Neurosurgery, California Institute of Neuroscience, Thousand Oaks, CA, USA
| | | | - Abdulmuqueeth Syed Kazmi
- Department of Neurosurgery, Windsor University School of Medicine, Brighton's Estate, Cayon, St. Kitts, West Indies
| | - Vishal Kwatra
- Department of Neurosurgery, California Institute of Neuroscience, Thousand Oaks, CA, USA
| | - Anirudh Ramachandran
- Department of Neurosurgery, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA
| | - Aaron Gustin
- Department of Neurosurgery, Advocate BroMenn Medical Center, Normal, IL, USA
| | - Mudassir Farooqui
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sajid Sattar Suriya
- Department of Neurosurgery, California Institute of Neuroscience, Thousand Oaks, CA, USA
| | - Atif Zafar
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
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Malachovsky I, Janickova M, Stasko J, Kasaj M, Sadlonova V, Novakova E, Gengelova P, Smatanová M, Statelová D. Pseudomonas Infection of the Temporomandibular Joint (TMJ) Health and Public Health Issues. ACTA MEDICA MARTINIANA 2017. [DOI: 10.1515/acm-2017-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The authors describe a case of a rare infectious disease of intra-articular tissues of the temporomandibular joint caused mainly by Pseudomonas aeruginosa. In scientific literature, under the heading invasive (malignant) external otitis, we can find cases of an infectious disease of the external acoustic meatus caused by a microbial agent of Pseudomonas aeruginosa which can subsequently penetrate into structures. However, a primary affliction of the abovementioned structures has not been described. Localisation and severity of the infection requires long-term and massive treatment with antibiotics.
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Affiliation(s)
- I. Malachovsky
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - M. Janickova
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - J. Stasko
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - M. Kasaj
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - V. Sadlonova
- Institute of Microbiology, Comeniu University, Jessenius Faculty of Medicine, Martin , Slovakia
| | - E. Novakova
- Institute of Microbiology, Comeniu University, Jessenius Faculty of Medicine, Martin , Slovakia
| | - P. Gengelova
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - M. Smatanová
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - D. Statelová
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Kollarova Str.N. 2,036 59, Martin , Slovak Republic
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7
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Singh A, Al Khabori M, Hyder MJ. Skull Base Osteomyelitis: Diagnostic and Therapeutic Challenges in Atypical Presentation. Otolaryngol Head Neck Surg 2016; 133:121-5. [PMID: 16025065 DOI: 10.1016/j.otohns.2005.03.024] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE: We sought to document the diagnostic and management difficulties in masked skull base osteomyelitis secondary to malignant otitis externa, with emphasis on establishing diagnostic criteria in recurrence. STUDY DESIGN: Retrospective analysis of 3 cases of inadequately treated malignant otitis externa in elderly diabetic individuals leading to recurrence and atypical manifestations of skull base osteomyelitis on contralateral side with or without multiple cranial nerve involvement. RESULTS: Two of the 3 cases died of the disease despite aggressive treatment. One case was treated successfully with combination of antipsuedamonal microbial drugs for 8 to 12 weeks and hyperbaric oxygen therapy. Major complications such as thrombosis of lateral sinus and internal jugular vein, meningitis, ophthalmoplegia, blindness, cervical spine erosion and paralysis of all cranial nerves with exception of Ist cranial nerve were observed. CONCLUSION: There is high morbitity and mortality associated with skull base osteomyelitis. In partially treated cases of malignant otitis externa, atypical symptoms and findings of unilateral severe otalgia, unremitting headache, and presence of high ESR, unilateral OME, constitute diagnostic clues of skull base osteomyelitis. Such cases require further investigation with CT, MRI, Technetium 99 and gallium 67 scintigraphy and aggressive management.
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Affiliation(s)
- Amar Singh
- Department of Otorhinolaryngology-Head and Neck Surgery and Communication Disorder, Al Nahdha Hospital, Muscat, Sultanate of Oman.
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Chakraborty D, Bhattacharya A, Gupta AK, Panda NK, Das A, Mittal BR. Skull base osteomyelitis in otitis externa: The utility of triphasic and single photon emission computed tomography/computed tomography bone scintigraphy. Indian J Nucl Med 2013; 28:65-9. [PMID: 24163508 PMCID: PMC3800313 DOI: 10.4103/0972-3919.118222] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Skull base osteomyelitis (SBO) refers to infection that has spread beyond the external auditory canal to the base of the skull in advanced stages of otitis externa. Clinically, it may be difficult to differentiate SBO from severe otitis externa without bony involvement. This study was performed to determine the role of three phase bone scintigraphy (TPBS) and single photon emission tomography/computed tomography (SPECT/CT) in detecting SBO. Materials and Methods: We retrospectively analyzed records of 20 patients (14 M, 6 F) with otitis externa and suspected SBO. TPBS and SPECT/CT of the skull were performed. Findings were correlated with clinical, laboratory and diagnostic CT scan findings. Results: All patients were diabetic with elevated erythrocyte sedimentation rate. A total of 18 patients had bilateral and two unilateral symptoms. Cranial nerves were involved in eight patients and microbiological culture of ear discharge fluid positive in seven. Early images showed increased temporal vascularity in nine patients and increased soft-tissue uptake in 10, while delayed images showed increased bone uptake in 19/20 patients. Localized abnormal tracer uptake was shown by SPECT/CT in the mastoid temporal (15), petrous (11), sphenoid (3) and zygomatic (1) and showed destructive changes in five. Thus, TPBS was found positive for SBO in 10/20 patients and changed the management in four. Conclusion: Our study suggests that TPBS with SPECT/CT is a useful non-invasive investigation for detection of SBO in otitis externa.
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Affiliation(s)
- Dhritiman Chakraborty
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
BACKGROUND Malignant, or necrotising, otitis externa is a potentially fatal infection of the external ear canal and surrounding soft tissue and bone. It may be complicated by involvement of cranial nerves, principally the facial nerves and the contents of the jugular foramen. It is an uncommon condition mainly found in the elderly or in diabetics. OBJECTIVES To assess the effectiveness of adjunctive hyperbaric oxygen treatment for malignant otitis externa. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 4 April 2013. SELECTION CRITERIA Randomised controlled trials, involving adults, undergoing hyperbaric oxygen therapy in malignant otitis externa. DATA COLLECTION AND ANALYSIS No identified articles described randomised controlled trials of hyperbaric oxygen therapy in the treatment of malignant otitis externa. MAIN RESULTS Due to the lack of data we could present no results. AUTHORS' CONCLUSIONS No clear evidence exists to demonstrate the efficacy of hyperbaric oxygen therapy when compared to treatment with antibiotics and/or surgery. We found no data to compare rates of complication between the different treatment modalities. Further research is required.
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Affiliation(s)
- John S Phillips
- Department of Otolaryngology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK.
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10
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Lilic N, Mowjood M, Wong M. A rare and sinister variant of a common ailment: Fungal malignant otitis externa. J Surg Case Rep 2012; 2012:4. [PMID: 24960790 PMCID: PMC3649617 DOI: 10.1093/jscr/2012.9.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A recent case report in this journal highlighted the pathophysiology and management of bacterial malignant otitis externa (MOE) (1). We describe the case of an elderly gentleman who had a delayed diagnosis of fungal MOE with advanced diseased at time of diagnosis. This case highlights the changing microbiology of this serious disease and the difficulty in diagnosis given the rarity of this form of otitis externa relative to its uncomplicated form.
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Affiliation(s)
- N Lilic
- Auckland City Hospital, Auckland, New Zealand
| | - Mt Mowjood
- Auckland City Hospital, Auckland, New Zealand
| | - Mhw Wong
- Auckland City Hospital, Auckland, New Zealand
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Abstract
AbstractObjective:To collect and analyse data from the published literature concerning the rare condition necrotising otitis externa, in order to formulate a prognostic scoring model based on signs and symptoms.Design:Retrospective data collection from published literature, and binary logistic regression analysis of the effect on outcome of identified signs and symptoms.Results:Six factors were identified as prognostic of a poorer outcome, including facial nerve involvement, additional cranial nerve involvement, non-cranial nerve neurological involvement, extensive granulations (or oedema) in the external auditory canal, bilateral symptoms and aspergillus species as the causative organism. A four-point scoring model based on these findings is presented.Conclusions:A novel, systematic method of data analysis was utilised to construct a prognostic scoring model for necrotising otitis externa. This will better equip clinicians to treat this potentially fatal condition.
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12
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Otites externes nécrosantes d’origine mycosique. ACTA ACUST UNITED AC 2008; 125:40-5. [DOI: 10.1016/j.aorl.2007.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 06/08/2007] [Indexed: 11/15/2022]
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Abstract
Dermatologic problems are common in diabetes, with approximately 30% of patients experiencing some cutaneous involvement during the course of their illness. Skin manifestations generally appear during the course of the disease in patients known to have diabetes, but they may also be the first presenting sign of diabetes or even precede the diagnosis by many years. The skin involvement can be autoimmune in nature, such as acanthosis nigricans, necrobiosis lipoidica, diabetic dermopathy, scleredema, and granuloma annulare, or infectious in the form of erythrasma, necrotizing fasciitis, and mucormycosis. Pharmacologic management of diabetes, in addition, can also result in skin changes, such as lipoatrophy and lipohypertrophy, at the site of injection of insulin, and oral antidiabetic agents can cause multiple skin reactions as adverse effects. The management of these cutaneous manifestations is tailored according to the underlying pathophysiology, but a tight control of blood glucose is a prerequisite in all management strategies.
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Affiliation(s)
- Intekhab Ahmed
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Abstract
BACKGROUND Malignant, or necrotising, otitis externa is a potentially fatal infection of the external ear canal and surrounding soft tissue and bone. It may be complicated by involvement of cranial nerves, principally the facial nerves and the contents of the jugular foramen. It is an uncommon condition mainly found in the elderly or in diabetics. OBJECTIVES To assess the effectiveness of adjunctive hyperbaric oxygen treatment for malignant otitis externa. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2003), MEDLINE (January 1966 to April 2004) and EMBASE (January 1985 to April 2004) with pre-specified terms. The date of the last search was 5th April 2004. SELECTION CRITERIA Randomised controlled trials, involving adults, undergoing hyperbaric oxygen therapy in malignant otitis externa. DATA COLLECTION AND ANALYSIS No identified articles described randomised controlled trials of hyperbaric oxygen therapy in the treatment of malignant otitis externa. MAIN RESULTS Due to the lack of data no results could be presented. AUTHORS' CONCLUSIONS No clear evidence exists to demonstrate the efficacy of hyperbaric oxygen therapy when compared to treatment with antibiotics and/or surgery. No data were found to compare rates of complication between the different treatment modalities. Further research is required.
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Affiliation(s)
- J S Phillips
- Department of Otolaryngology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, UK, NR4 7UY.
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15
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Dorko E, Jenca A, Orencák M, Virágová S, Pilipcinec E. Otomycoses of candidal origin in eastern Slovakia. Folia Microbiol (Praha) 2005; 49:601-4. [PMID: 15702553 DOI: 10.1007/bf02931541] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mycological analysis of swabs and scraping samples from the external ear canals of 40 patients with clinically diagnosed otomycosis (10 neonates, 30 adults) revealed the presence of fungi as etiological agents. They were investigated microscopically using 20 % potassium hydroxide, and by cultivation on Sabouraud's glucose agar. The Candida species were identified using the germ-tube test, micromorphology observations of colonies on rice agar, and particularly by the commercial kit AUXAcolor. The following Candida species were identified in the aural material examined: C. albicans (n = 21; 52.5 %), C. parapsilosis (11; 27.5), C. tropicalis (3; 7.5), C. krusei (3; 7.5), C. guilliermondii (2; 5.0). The above yeasts were present in samples together with Staphylococcus epidermidis (31), S. aureus (16), alpha-hemolytic streptococci (14), Neisseria spp. (14), Proteus mirabilis (3), Pseudomonas aeruginosa (3), Escherichia coli (1) and Haemophilus influenzae (1). The most frequent predisposing factors for otomycosis were swimming in public pools and/or bath, spa and diabetes mellitus.
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Affiliation(s)
- E Dorko
- Department of Epidemiology, Faculty of Medicine, Safárik University, 041 80 Kosice, Slovakia.
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16
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Freier MC, Babikian T, Pivonka J, Burley Aaen T, Gardner JM, Baum M, Bailey LL, Chinnock RE. A longitudinal perspective on neurodevelopmental outcome after infant cardiac transplantation. J Heart Lung Transplant 2004; 23:857-64. [PMID: 15261181 DOI: 10.1016/j.healun.2003.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2003] [Revised: 07/23/2003] [Accepted: 08/02/2003] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND With improvement in medical outcomes, the current research has shifted toward understanding and enhancing the quality of life after pediatric heart transplantation. Previous research has indicated that infant heart transplant recipients are generally at risk for neurodevelopmental delays; however, no longitudinal studies exploring the patterns of development within this medical population have been performed. METHODS Using the Bayley Scales of Infant Development-II, 39 children (2 to 38 months of age) who underwent heart transplantation in infancy (<1 year) at Loma Linda University Children's Hospital were assessed consecutively over time. RESULTS Mean Mental Development Index (MDI) scores for all age groups were within normal limits, except for the age ranges of 18 to 23 and 24 to 35 months, which were mildly delayed. Average Psychomoter Development Index (PDI) scores for all age groups reflected mildly delayed performance, except for the 36- to 38-month age group, which was within normal limits. Repeated measures analyses of variance on a sub-set of participants with at least 4 consecutive assessments revealed within-subject effects on MDI scores (F = 5.7, p < 0.01), but not on PDI scores (F = 1.6, p = 0.22). Significant decreases in MDI scores at 18 and 28 to 36 months were noted. CONCLUSIONS Motor development in this population was consistently mildly delayed. Age-dependent variability in cognitive skills was apparent. The delays appeared due to speech/language acquisition (18 months), and abstract reasoning/goal-directed behaviors (28 to 36 months). Possible etiologies for cognitive delays include test artifacts, auditory functioning and effects of immunosuppressive agents. Understanding risk factors in this patient population will allow for early and effective intervention.
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Affiliation(s)
- M Catherin Freier
- Department of Psychology, Loma Linda University, Loma Linda, CA 92350, USA
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Larson TC, Aulino JM, Laine FJ. Imaging of the glossopharyngeal, vagus, and accessory nerves. Semin Ultrasound CT MR 2002; 23:238-55. [PMID: 12168999 DOI: 10.1016/s0887-2171(02)90049-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The origination and course of the glossopharyngeal, vagus and accessory cranial nerves explains their function and localizes pathology. Abnormalities of these lower cranial nerves may be intrinsic or extrinsic and is due to a multiplicity of disease processes. The clinical presentation of the involved cranial nerve helps to guide imaging evaluation. Magnetic resonance imaging without and with contrast is the mainstay of imaging of cranial nerves IX, X and XI pathology, but computed tomography provides substantial information as well.
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Affiliation(s)
- Theodore C Larson
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232-2675, USA.
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18
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O'Brien NC, Charlton B, Cowden WB, Willenborg DO. Inhibition of nitric oxide synthase initiates relapsing remitting experimental autoimmune encephalomyelitis in rats, yet nitric oxide appears to be essential for clinical expression of disease. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2001; 167:5904-12. [PMID: 11698467 DOI: 10.4049/jimmunol.167.10.5904] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Myelin basic protein-CFA-induced experimental autoimmune encephalomyelitis (EAE) in Lewis rats is an acute monophasic disease from which animals recover. In this model, spontaneous relapses do not occur and rats develop a resistance to further active reinduction of disease. Previously, we reported that oral administration of the NO synthase inhibitor N-methyl-L-arginine acetate (L-NMA) to recovered rats precipitated a second episode of disease in 100% of animals. Further studies now show that this second clinical episode is actually a chronic relapsing disease that persists for months. This occurs only in rats that have recovered from actively induced EAE and not in rats recovered from passively induced EAE, suggesting the need for a peripheral Ag depot to induce secondary disease. We have also determined that clinical signs of EAE in L-NMA-treated recovered rats do not appear until L-NMA treatment has stopped. This is despite the fact that, at the same time point, CNS inflammatory lesions in symptomless animals receiving L-NMA are qualitatively and quantitatively similar to those with severe disease symptoms from whom L-NMA treatment has been withdrawn. The latter animals have significantly higher levels of reactive nitrogen intermediates in the cerebrospinal fluid than the former group. This study examines the mechanism of reinduction of disease by L-NMA treatment, and the findings suggest a dual role for NO in regulation of pathology in EAE that is dependent on site and timing of NO production.
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Affiliation(s)
- N C O'Brien
- Neurosciences Research Unit, Canberra Hospital, Woden, Australia.
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2000; 9:615-30. [PMID: 11338922 DOI: 10.1002/pds.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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