1
|
Ahmed AA, Rashid S, Gupta VK, Molony NC, Gupta KK. The diagnostic conundrum in necrotizing otitis externa. World J Otorhinolaryngol Head Neck Surg 2024; 10:59-65. [PMID: 38560038 PMCID: PMC10979047 DOI: 10.1002/wjo2.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/23/2023] [Accepted: 04/10/2023] [Indexed: 04/04/2024] Open
Abstract
Necrotizing otitis externa (NOE) is an aggressive and fast-evolving infection of the external auditory canal. Late diagnoses and untreated cases can lead to severe, even fatal consequences and so early diagnosis and treatment are paramount. NOE is a notoriously challenging diagnosis to make. It is therefore important to understand what diagnostic modalities are available and how otolaryngologists can use them to accurately treat such an aggressive disease. This review aims to evaluate the different diagnostic options available in NOE and discuss their advantages and limitations, thus, providing an up-to-date picture of the multimodal approach required in the diagnosis of this disease.
Collapse
Affiliation(s)
- Abiya A. Ahmed
- Bradford Royal InfirmaryBradford Teaching Hospitals NHS Foundation TrustWest BromwichWest YorkshireUK
| | - Shaan Rashid
- Bradford Royal InfirmaryBradford Teaching Hospitals NHS Foundation TrustWest BromwichWest YorkshireUK
| | - Vinay K. Gupta
- Sandwell and West Birmingham Hospitals NHS TrustWest BromwichUK
| | | | | |
Collapse
|
2
|
Noordiana SH, Mohammed Rusli ER, Nasseri Z, Abdullah A. Extensive Base of Skull Osteomyelitis: Why Does It Still Occur? Cureus 2024; 16:e51560. [PMID: 38173950 PMCID: PMC10762567 DOI: 10.7759/cureus.51560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 01/05/2024] Open
Abstract
Skull base osteomyelitis (SBO) is a rare yet serious intratemporal infection that often masquerades as a skull base malignancy. It is most common in diabetic and immunocompromised patients. We present a case of an elderly diabetic patient with end-stage renal disease with progressive malignant otitis externa. The disease progressed to involve the base of the skull, causing multiple cranial neuropathies. Early initiation of intravenous (IV) antibiotics, along with supportive treatment, may improve the long-term prognosis of the disease. This case highlights the importance of keeping a high index of diagnostic suspicion for SBO in patients with risk factors. Early diagnosis and prompt treatment can drastically decrease morbidity and mortality due to SBO.
Collapse
Affiliation(s)
- Siti Hajar Noordiana
- Otorhinolaryngology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, MYS
- Otorhinolaryngology, Hospital Sungai Buloh, Selangor, MYS
| | | | - Zara Nasseri
- Otolaryngology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, MYS
| | - Asma Abdullah
- Otolaryngology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, MYS
| |
Collapse
|
3
|
胡 丽, 高 雪, 王 曦, 徐 金, 王 晓. [Research progress of necrotizing otitis externa]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:843-847;852. [PMID: 37828893 PMCID: PMC10803230 DOI: 10.13201/j.issn.2096-7993.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Indexed: 10/14/2023]
Abstract
Necrotizing otitis externa is a progressive infectious disease involving the external auditory canal and even the skull base, which can lead to serious complications and even death if not treated in time. In this paper, the latest advances in etiology, pathogenesis, clinical manifestations, diagnosis and treatment were reviewed based on previous literature, providing reference for clinical diagnosis, treatment and future research.
Collapse
Affiliation(s)
- 丽敏 胡
- 火箭军特色医学中心耳鼻咽喉科(北京,100088)Department of Otorhinolaryngolgoy, PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - 雪 高
- 火箭军特色医学中心耳鼻咽喉科(北京,100088)Department of Otorhinolaryngolgoy, PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - 曦 王
- 火箭军特色医学中心耳鼻咽喉科(北京,100088)Department of Otorhinolaryngolgoy, PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - 金操 徐
- 火箭军特色医学中心耳鼻咽喉科(北京,100088)Department of Otorhinolaryngolgoy, PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - 晓东 王
- 火箭军特色医学中心研究部Department of Research, PLA Rocket Force Characteristic Medical Center
| |
Collapse
|
4
|
Hussain SZM, Haq II, Arshad Z, Ekunola A, Das S. Rare Cause of Skull Base Osteomyelitis: A Challenging Diagnosis and Management With a Literature Review. Cureus 2023; 15:e45838. [PMID: 37881401 PMCID: PMC10594066 DOI: 10.7759/cureus.45838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/27/2023] Open
Abstract
This is a case of skull base osteomyelitis (SBO) caused by a rare fungal species, Scedosporium apiospermum. This is a clinical case report with a review of the literature. SBO is a potentially life-threatening infection of the temporal bone. The patient presented to our hospital with a two-month history of left otalgia, otorrhea and reduced hearing, after failed initial intravenous antibiotic therapy. Thorough examination and further investigation confirmed the diagnosis of SBO caused by a rare fungal species, S. apiospermum. The patient was subsequently started on a long-term course of antifungals which led to an improvement of symptoms. This case highlights the importance of early recognition and considering early antifungal treatment in patients with persistent otalgia and otorrhea, particularly in those who have failed to respond to intravenous antibiotics. Further research is needed to better understand the optimal timing and duration of antifungal therapy in these patients.
Collapse
Affiliation(s)
| | - Ibrahim I Haq
- Ear, Nose and Throat (ENT), University Hospitals of Leicester NHS (National Health Service) Trust, Leicester, GBR
| | - Zaki Arshad
- Trauma and Orthopaedic Surgery, Cambridge University School of Clinical Medicine, Cambridge, GBR
| | - Ayomide Ekunola
- Ear, Nose and Throat (ENT), Leicester Royal Infirmary, Leicester, GBR
| | - Sudip Das
- Ear, Nose and Throat (ENT), Leicester Royal Infirmary, Leicester, GBR
| |
Collapse
|
5
|
田 俊. [Current diagnosis and treatment of skull base osteomyelitis]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:588-592. [PMID: 37549954 PMCID: PMC10570108 DOI: 10.13201/j.issn.2096-7993.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Indexed: 08/09/2023]
Abstract
Skull base osteomyelitis is a rare, refractory, and potentially fatal disease primarily caused by otogenic and sino rhinogenic infections. At times, it can mimic neoplasia complicating the diagnosis. With the use of antibiotics, advancements in diagnostic methods, and skull base surgical techniques, the mortality rate has significantly improved. However, the successful diagnosis and treatment of the disease is still challenging due to delayed diagnosis, lengthy treatment course, a tendency for relapse and lack of guidelines. Therefore, this article aims to review the progress in the diagnosis and treatment of skull base osteomyelitis.
Collapse
Affiliation(s)
- 俊 田
- 首都医科大学附属北京友谊医院耳鼻咽喉头颈外科(北京,100050)Department Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| |
Collapse
|
6
|
Vatakara A, Damle NA, Khurana A, Sagar S, Kumar R, Verma H. 99mTechnetium-Ubiquicidin Scan with Single-Photon Emission Computed Tomography/Computed Tomography in Skull Base Osteomyelitis. Indian J Nucl Med 2023; 38:297-300. [PMID: 38046968 PMCID: PMC10693375 DOI: 10.4103/ijnm.ijnm_192_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 12/05/2023] Open
Abstract
Malignant otitis externa (MOE) with skull base osteomyelitis (SBO) is an aggressive infection that predominantly affects elderly, diabetic, or immunocompromised patients, and is associated with high disease-specific mortality. Pseudomonas aeruginosa is the most isolated microorganism. External otitis associated with granulation tissue and pain is the most common presenting feature; a biopsy is obtained to rule out malignancy. A proper consensus is lacking regarding the best imaging modality for early initial diagnosis and follow-up. 99mTechnetium (99mTc)-labeled ubiquicidin (UBI) 29-41 is a bacterial attaching peptide that does not bind to activated leukocytes. We report a case of SBO initially misdiagnosed as a chronic otitis media, but later proved to be a case of MOE. 99mTc methylene diphosphonate bone scan and 99mTc-UBI 29-41 scan with single-photon emission computed tomography/computed tomography scans were performed to corroborate the clinical diagnosis. SBO remains a great challenge due to its increasing prevalence and high morbidity are difficult to diagnose and are often confused with cholesteatoma and neoplastic process. The UBI scan could be an auxiliary noninvasive diagnostic alternative in early diagnosis.
Collapse
Affiliation(s)
- Arunraj Vatakara
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | | | - Aditi Khurana
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sambit Sagar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Hitesh Verma
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
7
|
Ausekar S, Prasad KC, Babu P, Joseph L, G I. Clinical Spectrum and Treatment Response of Malignant Otitis Externa Patients: A Rural Tertiary Care Centre Experience. Cureus 2023; 15:e39518. [PMID: 37366442 PMCID: PMC10290759 DOI: 10.7759/cureus.39518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Malignant otitis externa (MOE) is an invasive external ear infection that has a tendency to spread through the temporal bone and can further progress to involve intracranial structures. Though the prevalence of MOE is rare, high morbidity and mortality are often associated. Complications of advanced MOE include cranial nerve involvement, most commonly facial nerve, and intracranial infections such as abscesses and meningitis. MATERIALS AND METHODS In this retrospective case series of nine patients diagnosed with MOE, demographic data, clinical presentations, laboratory data, and radiological findings were reviewed. All patients were followed up for a minimum period of three months after discharge. Outcomes were measured in terms of reduction in obnoxious ear pain (Visual Analogue Scale), ear discharge, tinnitus, need for re-hospitalization, recurrence of disease, and overall survival. RESULTS In our case series of nine patients (seven males and two females), six underwent surgery, and three patients were managed with a medical line of treatment. All patients had a significant reduction in otorrhea, otalgia, random venous blood sugars, and improvement of facial palsy implicating good response to treatment. CONCLUSION Prompt diagnosis of MOE warrants clinical expertise and aids in preventing complications. A prolonged course of intravenous anti-microbial agents is the mainstay of treatment, but timely surgical interventions in treatment-resistant cases can prevent complications.
Collapse
Affiliation(s)
- Shahrukh Ausekar
- Otolaryngology - Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - K C Prasad
- Otolaryngology - Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Prashanth Babu
- Otolaryngology - Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Lini Joseph
- Otolaryngology - Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Induvarsha G
- Otolaryngology- Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| |
Collapse
|
8
|
Takata J, Hopkins M, Alexander V, Bannister O, Dalton L, Harrison L, Groves E, Kanona H, Jones GL, Mohammed H, Andersson MI, Hodgson SH. Systematic review of the diagnosis and management of necrotising otitis externa: Highlighting the need for high-quality research. Clin Otolaryngol 2023; 48:381-394. [PMID: 36759416 DOI: 10.1111/coa.14041] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/30/2022] [Accepted: 01/28/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES To present a systematic review and critical analysis of clinical studies for necrotising otitis externa (NOE), with the aim of informing best practice for diagnosis and management. DESIGN Medline, Embase, Cochrane Library and Web of Science were searched from database inception until 30 April 2021 for all clinical articles on NOE. The review was registered on PROSPERO (ID: CRD42020128957) and conducted in accordance with PRISMA guidelines. RESULTS Seventy articles, including 2274 patients were included in the final synthesis. Seventy-three percent were retrospective case series; the remainder were of low methodological quality. Case definitions varied widely. Median patient age was 69.2 years; 68% were male, 84% had diabetes and 10% had no reported immunosuppressive risk factor. Otalgia was almost universal (96%), with granulation (69%) and oedema (76%) the commonest signs reported. Pseudomonas aeruginosa was isolated in 62%, but a range of bacterial and fungal pathogens were reported and 14% grew no organism. Optimal imaging modality for diagnosis or follow-up was unclear. Median antimicrobial therapy duration was 7.2 weeks, with no definitive evidence for optimal regimens. Twenty-one percent had surgery with widely variable timing, indication, or procedure. One-year disease-specific mortality was 2%; treatment failure and relapse rates were 22% and 7%, respectively. CONCLUSION There is a lack of robust, high-quality data to support best practice for diagnosis and management for this neglected condition. A minimum set of reporting requirements is proposed for future studies. A consensus case definition is urgently needed to facilitate high-quality research.
Collapse
Affiliation(s)
- Junko Takata
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.,Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Michael Hopkins
- Department of Ear, Nose and Throat Surgery, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Victoria Alexander
- Department of Ear, Nose and Throat Surgery, St George's University Hospital NHS Trust, London, UK
| | - Oliver Bannister
- Department of Infection, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Modernising Medical Microbiology, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lucy Dalton
- Department of Ear, Nose and Throat Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Laura Harrison
- Department of Ear, Nose and Throat Surgery, Royal Berkshire Hospital, Reading, UK
| | - Emily Groves
- Department of General Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Hala Kanona
- Department of Ear, Nose and Throat Surgery, The Royal National Ear Nose and Throat and Eastman Dental Hospital, University College London Hospitals NHS Trust, London, UK
| | | | - Hassan Mohammed
- Department of Ear, Nose and Throat, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Monique I Andersson
- Department of Infection, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Susanne H Hodgson
- Department of Infection, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Biochemistry, University of Oxford, Oxford, UK
| |
Collapse
|
9
|
Freeman MH, Perkins EL, Tawfik KO, O'Malley MR, Labadie RF, Haynes DS, Bennett ML. Facial Paralysis in Skull Base Osteomyelitis - Comparison of Surgical and Nonsurgical Management. Laryngoscope 2023; 133:179-183. [PMID: 35546515 DOI: 10.1002/lary.30161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 02/02/2023]
Abstract
TITLE Facial Paralysis in Skull Base Osteomyelitis - Comparison of Surgical and Nonsurgical Management. OBJECTIVE To compare outcomes of surgical and nonsurgical management in cases of facial paresis secondary to skull base osteomyelitis. METHODS A 14 patients presenting with skull base osteomyelitis complicated by facial nerve paresis at a single tertiary referral center from 2009 to 2019 were retrospectively reviewed. Patients were treated with medical therapy with or without surgical intervention, consisting of mastoidectomy and debridement with or without facial nerve decompression. House-Brackmann (HB) Grade was the main outcome measure. RESULTS A 14 patients (average age 68 years, range 58-82 years, 71% male) were analyzed, with 5 undergoing facial nerve decompression (36%), 5 undergoing mastoidectomy without facial nerve decompression (36%), and 4 undergoing medical management alone (28%). Of the 4 patients who underwent medical therapy alone, none experienced significant improvement in facial function. Of the 5 patients who underwent facial nerve decompression, 3 patients experienced improved facial function. Of the 5 patients who underwent mastoidectomy without decompression, 4 experienced improved facial function. There was no clear link between the severity of infection and the severity of facial paresis. When comparing HB score changes before and after treatment across groups, there was no statistically significant difference seen (p = 0.47). CONCLUSIONS Mastoidectomy and debridement with or without facial nerve decompression may improve facial nerve outcomes when compared to isolated medical management, although differences were not of statistical significance. The best facial nerve recoveries occurred in patients undergoing surgery within 14 days of the onset of paralysis. LEVEL OF EVIDENCE 4 - Case Series Laryngoscope, 133:179-183, 2023.
Collapse
Affiliation(s)
- Michael H Freeman
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth L Perkins
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kareem O Tawfik
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew R O'Malley
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert F Labadie
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David S Haynes
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
10
|
Lim JWJ, Hill FCE, Kerr S, Briggs R, McLean T. Diagnostic approach to patients at risk of otogenic skull base osteomyelitis. Acta Otolaryngol 2022; 142:272-279. [PMID: 35382682 DOI: 10.1080/00016489.2022.2057586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Otogenic skull base osteomyelitis (OSBO) is rare and potentially fatal sequelae of otitis externa. Accurate and timely diagnosis is important due to rising incidence, morbidity and costs associated with treatment. Consensus on the diagnostic approach for OSBO has yet to be reached, in particular the utility of imaging modalities. AIMS/OBJECTIVES This study reviews a single institution's high-volume experience of OSBO, with the aim of analysing clinicopathologic features and imaging studies to develop a diagnostic algorithm. MATERIAL AND METHODS A retrospective review of patients admitted with OSBO from 2009 to 2019, was performed. After applying inclusion and exclusion criteria, 103 patients with 106 unique episodes of suspected OSBO were selected. De-identified information including patient demographics, clinicopathologic features and imaging outcomes was recorded and analysed. RESULTS HbA1c ≥ 7% significantly predicted for OSBO in univariate (OR 7.83, 95% CI 1.85-33.16, p = 0.01) and multivariate analyses (OR 5.21, 95% CI 1.05-25.81, p = 0.04). The CT/technetium-99m/gallium-67 combination produced better diagnostic accuracy for OSBO (AUROC 0.96, 95% CI 0.92-1), when compared to a CT/MRI combination (AUROC 0.86, 95% CI 0.79-0.93). CONCLUSIONS AND SIGNIFICANCE Once there is a clinical suspicion for OSBO, diagnosis is established by synthesising results from clinical assessment, pathologic investigations and imaging modalities. The imaging utilised to diagnose OSBO should vary according to the clinical situation and limitations of each modality.
Collapse
Affiliation(s)
- Jason Wei Jun Lim
- Department of Otolaryngology, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Fiona C. E. Hill
- Department of Otolaryngology, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Stephen Kerr
- The Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Robert Briggs
- Department of Otolaryngology, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Tim McLean
- Department of Otolaryngology, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| |
Collapse
|
11
|
Ijaz A, Williams E, Cole J, Watson G. Necrotising Otitis Externa Antibiotic therapy complications: A retrospective cohort analysis. Clin Otolaryngol 2022; 47:491-494. [PMID: 35194951 DOI: 10.1111/coa.13921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
NOE is a rare but life-threatening condition. Treatment is long-term intravenous antibiotics. However, there is no evidence on the complications of antibiotic treatment in this complex cohort of patients In our study, patients on average are treated with two different antibiotic regimes 63% of these changes in regimen are due to direct adverse effects from treatment including drug intolerance and lack of significant clinical response leading to deterioration and morbid complications Patients requiring multiple antibiotic regimes have a statistically longer duration of treatment. These adverse effects appear to occur more frequently in patients with additional comorbidities. This novel data provides information clinicians can use when initiating treatment for NOE and counsel patients appropriately.
Collapse
Affiliation(s)
- Ali Ijaz
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF
| | - Emma Williams
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF
| | - Joby Cole
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF
| | - Glen Watson
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF
| |
Collapse
|
12
|
Kayode-Ajala F, Williams N, Ejikeme C, Walji A, Farrer W. A Case of Adult Clival Osteomyelitis. J Investig Med High Impact Case Rep 2022; 10:23247096221101858. [PMID: 35608025 PMCID: PMC9134395 DOI: 10.1177/23247096221101858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/17/2022] [Accepted: 05/01/2022] [Indexed: 11/16/2022] Open
Abstract
Clival osteomyelitis is a potentially life-threatening skull base infection. It is rare and generally challenging to diagnose and treat. Clival osteomyelitis is typically seen in the pediatric population and is very rare in the adult population. It occurs as a complication of recurring paranasal infections and malignant otitis externa. The exact pathophysiology of osteomyelitis of the clivus is relatively uncertain. Here, we describe a case of a 36-year-old man with medical history significant for hypertension and poorly controlled type 1 diabetes mellitus who experienced recurrent paranasal sinus infection for 2 years. He received multiple antibiotic treatments and underwent adenoidectomy without substantial improvement of symptoms. Ultimately, a diagnosis of the clival osteomyelitis through the help of a computed tomography (CT) scan of the paranasal sinus and neck was made. This diagnosis allowed for adequate intervention and treatment of our patient with subsequent resolution of his presenting symptoms. This case highlights the importance of high suspicion for clival osteomyelitis in patients with recurring sinus infections.
Collapse
Affiliation(s)
- Fisayo Kayode-Ajala
- Robert Wood Johnson Barnabas Health and
Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Neil Williams
- Robert Wood Johnson Barnabas Health and
Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Chidinma Ejikeme
- Robert Wood Johnson Barnabas Health and
Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Ali Walji
- St. George’s University, West Indies,
Grenada
| | - William Farrer
- Robert Wood Johnson Barnabas Health and
Trinitas Regional Medical Center, Elizabeth, NJ, USA
| |
Collapse
|
13
|
Gunawardena T, Godakandage M, Abeywickrama S, Cassim R, Wijeyaratne M. Mycotic aortic aneurysm in a debilitated patient with compromised immunity; beware of Candida! J Vasc Bras 2021; 20:e20210122. [PMID: 34925475 PMCID: PMC8668086 DOI: 10.1590/1677-5449.210122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/01/2021] [Indexed: 11/21/2022] Open
Abstract
Candida is a rare cause of infected aortic aneurysms. We report the case of a diabetic patient with end stage kidney disease who underwent repair of a leaking abdominal aortic aneurysm. He was on long-term antibiotic treatment for malignant otitis externa. Candida albicans was isolated from the culture of the excised aneurysm wall. An infected aortic aneurysm due to Candida has not been previously reported in a patient with malignant otitis externa. This case report aims to highlight that Candida should be suspected as a cause of infected aortic aneurysms in patients with debilitation and chronic immunosuppression. Management of such cases can be extremely challenging, especially in resource-poor settings, and we will be touching upon the advantages and disadvantages of various treatment options.
Collapse
Affiliation(s)
- Thilina Gunawardena
- The Royal Liverpool University Hospital, Liverpool, the United Kingdom.,National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | - Sachith Abeywickrama
- The Royal Liverpool University Hospital, Liverpool, the United Kingdom.,Worcestershire Acute Care Hospitals, the United Kingdom
| | - Rezni Cassim
- The Royal Liverpool University Hospital, Liverpool, the United Kingdom
| | | |
Collapse
|
14
|
Khan HA. Necrotising Otitis Externa: A Review of Imaging Modalities. Cureus 2021; 13:e20675. [PMID: 34966623 PMCID: PMC8710300 DOI: 10.7759/cureus.20675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2021] [Indexed: 11/25/2022] Open
Abstract
Necrotising Otitis Externa (NOE) has often posed some challenges in view of diagnosis and management by clinicians. One such challenge is the appropriate and timely use of imaging techniques since its use is critical not only in diagnosis but also in determining the extent and resolution of the disease. Hence, doctors in both primary and secondary health care need to be familiar with presenting symptoms while specialists need to be appraised of advances in imagining techniques in diagnosis and management of NOE. Whilst there is a general consensus amongst clinicians on some aspects of management of NOE, there is very limited consensus on the use of imaging modalities. There is no single modality of imaging that can provide a complete picture of diagnosis, disease progression and resolution. This review aims to highlight the strengths and weaknesses of various imaging techniques used in the diagnosis and management of NOE over the years and whether a multi-modal imaging technique at particular stages of the disease may provide better management outcomes.
Collapse
Affiliation(s)
- Hammaad A Khan
- Otolaryngology - Head and Neck Surgery, Aintree University Hospital, Liverpool, GBR
| |
Collapse
|
15
|
Selvamalar V, Othman NAN, Daud MK. A Case Series of Malignant Otitis Externa Mimicking Malignancy. Acta Medica (Hradec Kralove) 2021; 64:36-41. [PMID: 33855957 DOI: 10.14712/18059694.2021.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Malignant otitis externa is an inflammation of the external auditory canal with preceding osteomyelitis of the temporal bone and the adjacent structures that could be potentially lethal. Malignant otitis externa may present with cranial nerve involvements and massive spread of disease mimicking nasopharyngeal carcinoma or any other malignancies on imaging. Two elderly patients who presented with severe otalgia and significant facial nerve palsy and lower cranial nerve palsies showing extensive spread of disease are reported in this case series. They both had resolution of disease after a prolonged course of antibiotics and cortical mastoidectomy for disease clearance in one of them.
Collapse
Affiliation(s)
- Vengathajalam Selvamalar
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Nik Adilah Nik Othman
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. .,Hospital University Sains Malaysia, Health Campus, Kubang Kerian, 16150, Kelantan, Malaysia.
| | - Mohd Khairi Daud
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Hospital University Sains Malaysia, Health Campus, Kubang Kerian, 16150, Kelantan, Malaysia
| |
Collapse
|
16
|
Abstract
Otitis externa is an infection of the external auditory canal. It rarely results in facial palsy except in severe cases such as necrotizing otitis externa, which is a life-threatening invasive infection of the external auditory canal. Early recognition with prompt and appropriate treatment of necrotizing otitis externa is crucial to prevent more sinister complications. Here we report a case of an elderly gentleman who presented with otitis externa and developed facial palsy a month later. We identified possible problems that may have led to the complication so that such an occurrence can be prevented in the future.
Collapse
Affiliation(s)
- Aliyya Badaruddin
- MB, BCh, BAO, MOphthal, Department of Ophthalmology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
| | - May May Choo
- FRCS, Department of Ophthalmology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| |
Collapse
|
17
|
Guimaraes GC, de Freitas PP, da Silva VAR, Castilho AM. Conservative management of petrous apex abscess and Gradenigo's syndrome in a diabetic patient: Case report and literature review. Clin Case Rep 2021; 9:742-746. [PMID: 33598237 PMCID: PMC7869396 DOI: 10.1002/ccr3.3625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/23/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022] Open
Abstract
The case reported evidences the possibility of nonsurgical treatment in patients with abscesses located in regions difficult to reach surgically due to surgical limitations or possible sequelae related to surgical procedure.
Collapse
|
18
|
Di Lullo AM, Russo C, Grimaldi G, Capriglione P, Cantone E, Del Vecchio W, Motta G, Iengo M, Elefante A, Cavaliere M. Skull Base Fungal Osteomyelitis: A Case Report and Review of the Literature. Ear Nose Throat J 2020; 100:1089S-1094S. [PMID: 32584614 DOI: 10.1177/0145561320936006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Skull base osteomyelitis (SBO) is an invasive infection refractory to therapy, closely linked with malignant otitis externa (MOE). It is characterized by a mild clinical presentation that can delay cross-sectional imaging considered as the key to revealing it. Skull base osteomyelitis typically affects elderly diabetics and immunocompromised patients (>70 years). It most commonly has an otogenic origin due to an extension of MOE. The prognosis can be very poor without the administration of adequate and timely therapy at an early disease stage. Nowadays, Pseudomonas aeruginosa remains the most common pathogen associated with SBO. Fungi are a rare cause of MOE. This report documents a rare case of otogenic SBO caused by Candida parapsilosis in a diabetic patient, with persistent otologic symptoms as clinical onset and resistance to medical treatment. Fungal MOE has more subtle symptoms and is more aggressive than its bacterial counterpart. When MOE is resistant to antibacterial drugs, this should raise the suspicion of a fungal etiology of MOE. The current guidelines do not exhaustively describe the diagnosis, antifungal drugs of choice, and optimum duration of treatment. The description of these rare clinical cases should help with the multidisciplinary management of this disease in order to optimize the diagnosis and therapeutic protocol.
Collapse
Affiliation(s)
- Antonella M Di Lullo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology-Head and Neck Surgery Unit, University of Naples Federico II, Italy.,CEINGE-Advanced Biotechnology, Naples, Italy
| | - Camilla Russo
- Department of Advance Biomedical Sciences, Neuroradiology Unit, University of Naples Federico II, Italy
| | - Giusy Grimaldi
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology-Head and Neck Surgery Unit, University of Naples Federico II, Italy
| | - Pasquale Capriglione
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology-Head and Neck Surgery Unit, University of Naples Federico II, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology-Head and Neck Surgery Unit, University of Naples Federico II, Italy
| | - Walter Del Vecchio
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
| | - Gaetano Motta
- Department of Mental and Physical Health and Preventive Medicine, Otorhinolaryngology-Head and Neck Surgery Unit, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Maurizio Iengo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology-Head and Neck Surgery Unit, University of Naples Federico II, Italy
| | - Andrea Elefante
- Department of Advance Biomedical Sciences, Neuroradiology Unit, University of Naples Federico II, Italy
| | - Michele Cavaliere
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology-Head and Neck Surgery Unit, University of Naples Federico II, Italy
| |
Collapse
|
19
|
Arsovic N, Radivojevic N, Jesic S, Babac S, Cvorovic L, Dudvarski Z. Malignant Otitis Externa: Causes for Various Treatment Responses. J Int Adv Otol 2020; 16:98-103. [PMID: 32209516 PMCID: PMC7224427 DOI: 10.5152/iao.2020.7709] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/06/2019] [Accepted: 12/13/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Malignant (necrotizing) otitis externa (MOE) is an aggressive form of skin inflammation of the external ear with a tendency to spread infection to the temporal bone. The study aimed to evaluate a causal relationship between treatment responses and clinical features in patients with MOE. MATERIALS AND METHODS In a retrospective, descriptive section study, the database was analyzed between January 2008 and December 2018 in our department, all patients with diagnosed MOE were identified. RESULTS A total of 30 patients were evaluated, of which 27 men and 3 women. The youngest patient was 52 years old while he was eldest 88 years, (mean-71 years old). As the most common comorbidity, diabetes mellitus was found in 23 (76%) subjects. Median duration of symptoms was about 3 months. The most common isolated pathogen was Pseudomonas aeruginosa (47%). Patients with facial nerve palsy and erosion of temporal bone find on computerized tomography affect prolonged stationary treatment (Mean, SD 29.2±8.5 and 26,7±11.6 days), while 80% of patients with facial nerve palsy had recurrence of disease (p=0.005) with mean duration of clinical remission of 60±17.3 days. Overall length of treatment is also increased in the presence of comorbidities as well as in patients with cranial nerve involvement. CONCLUSION Patients with cranial nerve involvement, erosion of temporal bone and presence of comorbidities affect prolonged treatment and adverse prognosis. Early diagnosis and initiation of aggressive therapy are essential for stopping the further spread of the disease and prevention of serious complications.
Collapse
Affiliation(s)
- Nenad Arsovic
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Nemanja Radivojevic
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Snezana Jesic
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Snezana Babac
- Clinic of ENT, Clinical and Hospital Centre Zvezdara, Belgrade, Serbia
| | - Ljiljana Cvorovic
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Zoran Dudvarski
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia
| |
Collapse
|
20
|
Abstract
We report a case of malignant otitis externa with jugular vein thrombosis caused by Aspergillus flavus. Magnetic resonance imaging revealed an unusual ink smudge pattern deep in a cervical abscess. The pattern was consistent with mycetoma and may be important for diagnosing these life-threatening infections.
Collapse
|
21
|
Yoon JH, Cho SH, Lee SH, Ma SK, Kim SW, Bae EH. Central Diabetes Insipidus Associated with Orbital Apex Syndrome. J NIPPON MED SCH 2019; 86:254-257. [PMID: 31484882 DOI: 10.1272/jnms.jnms.2019_86-409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Orbital apex syndrome (OAS) manifests as multiple cranial nerve palsies caused by an abnormal nerve response to inflammation or other processes. Central diabetes insipidus (CDI) is characterized by deficient synthesis or secretion of antidiuretic hormone. A 62-year-old woman underwent myringotomy for otitis media with effusion. Two months after the procedure, symptoms of hearing loss had not improved, and she underwent left tympanoplasty and mastoidectomy. After surgery, she presented with left ocular pain and visual loss. Neurologic examination revealed ptosis, total ophthalmoplegia, and a relative afferent pupillary defect on the left eye. Magnetic resonance imaging showed an asymmetric contrast-enhancing lesion in the left orbital apex and left cavernous sinus, with adjacent dural thickening and enhancement. OAS was diagnosed, and steroid treatment was started. During the regular follow-up period, she reported polyuria, and CDI was diagnosed. Treatment with intranasal desmopressin 10 μg twice daily was started, and symptoms greatly improved. The mechanism underlying the association of CDI with OAS is unclear, and further research is needed. The present case suggests that polyuria in OAS should alert neurologists and ophthalmologists to possible CDI.
Collapse
Affiliation(s)
- Jung Hwan Yoon
- Department of Internal Medicine, Chonnam National University Medical School
| | - Su Hyeon Cho
- Department of Internal Medicine, Chonnam National University Medical School
| | - Seung-Han Lee
- Department of Neurology, Chonnam National University Medical School
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School
| |
Collapse
|
22
|
Chen YJ, Wen WH, Lin KN, Chen JW. Otorrhoea with facial palsy in a child. Arch Dis Child 2019; 104:879. [PMID: 29858271 DOI: 10.1136/archdischild-2018-315026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Yi-Jia Chen
- Department of Otolaryngology-Head and Neck Surgery, Catholic Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Wan-Hsin Wen
- Department of Pediatrics, Catholic Cardinal Tien Hospital, New Taipei City, Taiwan.,School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Kai-Nan Lin
- Department of Otolaryngology-Head and Neck Surgery, Catholic Cardinal Tien Hospital, New Taipei City, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jeng-Wen Chen
- Department of Otolaryngology-Head and Neck Surgery, Catholic Cardinal Tien Hospital, New Taipei City, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| |
Collapse
|
23
|
Affiliation(s)
- Florian Simon
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität München, Marchioninistr. 15, D-81377, München, Deutschland.
| | - J -M Hempel
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität München, Marchioninistr. 15, D-81377, München, Deutschland
| |
Collapse
|
24
|
Rihl MF, Bau FM, de Oliveira I, Vivan MA, Marchiori RC. Malignant otitis externa in a 21-year-old male patient with Prader-Willi syndrome. SAGE Open Med Case Rep 2019; 7:2050313X19834827. [PMID: 30858975 PMCID: PMC6404052 DOI: 10.1177/2050313x19834827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/06/2019] [Indexed: 12/03/2022] Open
Abstract
Malignant otitis externa is an invasive infection of the external auditory canal
and temporal bone with potentially life-threatening complications. Elderly
patients with type 2 diabetes mellitus are the population most commonly affected
by malignant otitis externa, but any type of immunosuppression predisposes to
the disease. Prader–Willi syndrome is a genetic cause of obesity, often
associated with insulin resistance and type 2 diabetes mellitus. This report
describes a case of a 21-year-old male patient with Prader–Willi syndrome who
had malignant otitis externa that progressed to sepsis during hospitalization.
To the best of the authors’ knowledge, this is the first description of
malignant otitis externa in a young patient with Prader–Willi syndrome.
Collapse
Affiliation(s)
- Marcos Frata Rihl
- Department of Internal Medicine, Hospital Conceição, Porto Alegre, Brazil
| | | | | | | | | |
Collapse
|
25
|
AlEnazi AS, Al Sharhan SS, Telmesani LM, Aljazan NA, Al Qahtani BM, Lotfy MA. The Impact of using the term "Diabetic Ear" for the patients with Skull Base Osteomyelitis. J Family Community Med 2019; 26:23-29. [PMID: 30697101 PMCID: PMC6335838 DOI: 10.4103/jfcm.jfcm_187_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Diabetes and ear disease are some of the most widespread health concerns. The focus here is on the impact of using the term “Diabetic Ear” for patients with skull base osteomyelitis (SBM) in the context of malignant otitis externa (MOE). The aim of this study was to discover the awareness of general practitioners (GPs), residents, specialists, and consultants at Primary Health Care Centers about necrotizing otitis externa (NOE), also known previously as malignant external otitis (MOE), assess their deficiencies and provide solutions; also assist them for the early detection and possible prevention of diabetes- related ear diseases and their complications. MATERIALS AND METHODS: A cross-sectional study was conducted among a random sample of physicians (residents, specialists, and consultants) working at the Primary Health Care Centers in Al-Khobar and Dammam cities of the Eastern Province, Saudi Arabia. Data was collected using a standardized questionnaire. SPSS was used for data entry and analysis. RESULTS: The total number of medical practitioners was 84. Their mean age was 33.97 (±9.55). The proportion of females was higher than males, only 28.3% of the participants responded correctly when asked about MOE. Similarly, very few were aware of the risks of MOE (2.5%), complications associated with it (17.3%) and the necessary procedures for managing patients (24.2%). The awareness of doctors in the primary health clinics about MOE was significantly better than those in hospitals (P = 0.002). CONCLUSION: There was a significant deficiency in the knowledge of GPs on MOE. Therefore, health education and awareness programs on MOE are recommended. Furthermore, we recommend that it is necessary to encourage the use of the term “Diabetic EAR “to increase the level of awareness of physicians about MOE.
Collapse
Affiliation(s)
- Abdulaziz S AlEnazi
- Department of Otorhinolaryngology - Head and Neck Surgery, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Salma S Al Sharhan
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, KFUH, Al-Khobar, Saudi Arabia
| | - Laila M Telmesani
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, KFUH, Al-Khobar, Saudi Arabia
| | - Nasser A Aljazan
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, KFUH, Al-Khobar, Saudi Arabia
| | - Bander M Al Qahtani
- Department of Otorhinolaryngology - Head and Neck Surgery, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mohamed A Lotfy
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, KFUH, Al-Khobar, Saudi Arabia
| |
Collapse
|
26
|
Hatch JL, Bauschard MJ, Nguyen SA, Lambert PR, Meyer TA, McRackan TR. Malignant Otitis Externa Outcomes: A Study of the University HealthSystem Consortium Database. Ann Otol Rhinol Laryngol 2018; 127:514-520. [PMID: 29962250 DOI: 10.1177/0003489418778056] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To characterize factors that affect outcomes for patients with malignant otitis externa (MOE). METHODS Retrospective review of inpatients with MOE was performed. Patient demographics, comorbid conditions, complications, procedures, and mortalities were analyzed. RESULTS A total of 786 patients with MOE were identified. The mean hospitalization length of stay (LOS) was 18.6 days (SD = 19.7). The overall mortality rate was 2.5% (n = 20), and complication rate was 4.3% (n = 34). Increasing age significantly and positively correlated with the incidence of MOE (r = 0.979, P < .0001). Factors that were associated with an increased rate of mortality were sepsis (odds ratio [OR] = 18.5; ES = 0.94; 95% CI, 0.47-1.42), congestive heart failure (OR = 3.1; ES = 0.42; 95% CI, 0.02-0.82), weight loss (OR = 10.2; ES = 1.23; 95% CI, 0.61-1.85), and coagulopathy (OR = 8.8; ES = 1.84; 95% CI, 0.91-2.77). Surgical intervention was performed in 19.2% (n = 151) of patients. Facial nerve involvement was present in 15.5% (n = 122) of patients and was associated with a significantly longer LOS of 12.9 days (SD = 19.6; ES = 0.21; 95% CI, 0.03-0.41). CONCLUSIONS This large multi-institutional database study of MOE demonstrates that several patient factors impact the LOS and mortality. Patients at risk for unfavorable outcomes include the elderly, male gender, comorbidities, or cranial nerve involvement.
Collapse
Affiliation(s)
- Jonathan L Hatch
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael J Bauschard
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul R Lambert
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A Meyer
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore R McRackan
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
27
|
Hasibi M, Ashtiani MK, Motassadi Zarandi M, Yazdani N, Borghei P, Kuhi A, Dabiri S, Hosseini R, Sardashti S. A Treatment Protocol for Management of Bacterial and Fungal Malignant External Otitis: A Large Cohort in Tehran, Iran. Ann Otol Rhinol Laryngol 2017; 126:561-567. [PMID: 28528568 DOI: 10.1177/0003489417710473] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIMS High rates of negative microbiologic test results highlight the potential role of empiric antimicrobial agents in management of malignant otitis externa (MOE). This study investigates the clinical presentation, laboratory findings, and response to empiric treatment in a large group of patients admitted to a tertiary academic hospital in Tehran, Iran. METHODS AND MATERIALS We recruited 224 patients diagnosed with MOE in a prospective observation from 2009 through 2015. All patients received a 2-agent antibacterial regimen at baseline (phase I). Patients with no improvement within 10 days and/or nonresponders to a second course of antibacterials were switched to antifungals (phase II). Response to treatment was observed and documented in both groups. RESULTS All patients had physical symptoms for more than 12 weeks before admission. In total, 127 patients responded well to antibacterials. Eighty-seven out of 97 patients who were switched to antifungals had complete response to treatment; patients in the latter group had significantly higher A1C levels at baseline. CONCLUSION Our findings provide evidence to develop clinical guidelines that accelerate diagnosis and treatment of MOE to improve patient outcomes.
Collapse
Affiliation(s)
| | | | | | - Nasrin Yazdani
- 2 Tehran University of Medical Sciences Department and Research Center of Otolaryngology Head and Neck Surgery, Tehran, Iran, Islamic Republic Of
| | | | - Ali Kuhi
- 1 Amir-Alam Hospital, Tehran, Iran, Islamic Republic Of
| | - Sasan Dabiri
- 1 Amir-Alam Hospital, Tehran, Iran, Islamic Republic Of
| | - Reza Hosseini
- 3 Imam Khomeini Hospital, Tehran, Iran, Islamic Republic Of
| | - Sara Sardashti
- 4 Iranian Research Center for HIV/AIDS, Tehran, Iran, Islamic Republic Of
| |
Collapse
|
28
|
Abstract
Of the many patterns of peripheral nerve disorders in diabetes mellitus (DM), isolated clinical involvement of single nerves, though less common than distal symmetric polyneuropathy and perhaps polyradiculoneuropathy, constitute an important collection of characteristic syndromes. These fall into four anatomical regions of the body: cranial, upper limb, truncal, and lower limb territories. Each of these groups of mononeuropathies has its own ensemble of epidemiologic patterns, clinical presentations, laboratory and radiologic findings, differential diagnosis, management principles and prognosis.
Collapse
Affiliation(s)
- Benn E Smith
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA.
| |
Collapse
|