A review of thirty‐nine patients diagnosed with necrotising otitis externa over three years: Is CT imaging for diagnosis sufficient?

Lau, Kimberley; Scottà, Gianluca; Wu, K; Kabuli, Mohammed Asim Khan; Watson, Glen

doi:10.1111/coa.13507

Cited by 12 publications

(25 citation statements)

References 11 publications

(21 reference statements)

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“…In our study, all the patients were diabetic, and two had uncontrolled diabetes (monitoring HbA1c status). In fact, 80% diabetic patients have an increased risk of developing MEO [ 4 ]. That is owing to endarteritis, obliterating microangiopathies, and the high rate of infection that can cause ischemia and hypoxia of soft tissue in diabetic subjects [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Data from the literature show that high-resolution CT scan with multiplanar reformat is most commonly used as the first diagnostic approach [ 4 ], as it reveals bone erosion and demineralization. However, in early stages of MEO, bony erosion may not be evident [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, in early stages of MEO, bony erosion may not be evident [ 19 ]. Although CT scan can be used to assess soft tissue swelling and upper airway obstruction, contrast-enhanced MRI is the gold standard for soft tissue evaluation for a variety of head and neck and skull base disorders [ 4 , 25 – 32 ]. MRI (with reference to post-contrast volumetric T1w images) is particularly effective in assessing retrocondylar, parapharyngeal, masticator, parotid, and paraclival soft tissue invasion, and intracranial extension.…”

Section: Discussionmentioning

confidence: 99%

“…MRI (with reference to post-contrast volumetric T1w images) is particularly effective in assessing retrocondylar, parapharyngeal, masticator, parotid, and paraclival soft tissue invasion, and intracranial extension. With MRI, all four main routes of infection spread (anteriorly by temporomandibular joint, masticator space, and parotid gland; posteriorly by mastoid bone; medially by ipsilateral parapharyngeal fatty tissue and paraclival soft tissue; superiorly with dural involvement and intracranial extension) can be easily assessed [ 4 ]. With this background, all our patients underwent CT and then contrast-enhanced MRI to confirm diagnosis and for follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…It can affect the external auditory canal up to the temporal bone (mastoid process) and the skull base [ 1 – 3 ]. Diagnosis can be delayed with significant morbidity and mortality [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Malignant Otitis External: Our Experience and Literature Review

et al. 2020

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Case series Patients: Male, 74-year-old • Male, 76-year-old • Male, 77-year-old Final Diagnosis: Malignant otitis externa Symptoms: Edema • facial paralysis • hearing loss • otalgia and major otorrhea in the right ear Medication: — Clinical Procedure: ENT examination Specialty: Otolaryngology Objective: Unusual clinical course Background: Malignant external otitis (MEO) is an invasive infection that can involve the external auditory canal and the skull base up to the contiguous soft tissues. Considering the changing face of MEO, we reviewed cases of MEO treated in our Ear Nose Throat (ENT) clinic – University Federico II of Naples between 2018 and 2019 to evaluate the current epidemiology of the condition and to assess the state of art on diagnosis, therapeutic and follow-up management in our patients. Case Reports: We present the cases of three male patients with Type 2 diabetes mellitus who complained of long-lasting otorrhea and pain, with clinical suspicion of MEO. In all cases, ear swab was positive for Pseudomonas aeruginosa . All our patients received a 6-week course of intravenous ciprofloxacin, piperacillin, and tazobactam, with rapid clinical symptoms improvement and complete recovery at 1-year follow-up. Conclusions: MEO is difficult to treat due to the lack of standardized care guidelines. Patients with MEO often present with severe otalgia, edema, otorrhea, and facial nerve paralysis. Clinicians must suspect MEO in elderly diabetic and immunocompromised patients with persistent otalgia after external otitis. Imaging (computed tomography and magnetic resonance imaging) can play synergistic roles in the management of MEO. To evaluate eradication of the disease, clinicians have to assess clinical symptoms and signs as well as radiological imaging and inflammatory markers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Malignant Otitis External: Our Experience and Literature Review

et al. 2020

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Diagnosing necrotizing external otitis on CT and MRI: assessment of pattern of extension

Meer

Waterval

Kunst

et al. 2021

Eur Arch Otorhinolaryngol

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Background and purpose Necrotizing external otitis (NEO) is a serious complication of external otitis. NEO can be classified according to—anterior, medial, posterior, intracranial, and contralateral—extension patterns. Currently there is no consensus on the optimal imaging modality for the identification of disease extension. This study compares NEO extension patterns on MR and CT to evaluate diagnostic comparability. Methods Patients who received a CT and MR within a 3-month interval were retrospectively examined. Involvement of subsites and subsequent spreading patterns were assessed on both modalities by a radiologist in training and by a senior head and neck radiologist. The prevalence of extension patterns on CT and MR were calculated and compared. Results All 21 included NEO cases showed an anterior extension pattern on CT and MR. Contrary to MR, medial extension was not recognized on CT in two out of six patients, and intracranial extension in five out of eight patients. The posterior extension pattern was not recognized on MR. Overall, single anterior extension pattern (62%) is more prevalent than multiple extension patterns (38%). Conclusion All anterior NEO extension pattern were identified on CT as well as MR. However, the medial and intracranial spreading patterns as seen on MR could only be identified on CT in a small number of patients. The posterior spreading pattern can be overlooked on MR. Thus, CT and MR are complimentary for the initial diagnosis and work-up of NEO as to correctly delineate disease extent through the skull base.

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