Initial management of necrotizing external otitis: Errors to avoid

Guevara, N.; Mahdyoun, P.; Pulcini, Céline; Raffaelli, Charles; Gahide, I.; Castillo, L.

doi:10.1016/j.anorl.2012.04.011

Cited by 27 publications

(31 citation statements)

References 24 publications

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“…Bacterial culture and susceptibility testing provide the basis for antibiotic selection [5]. While EAC specimens can be sent for bacterial culture, results are often negative, and a bone biopsy may be necessary to guide antibiotic selection [5]. In the absence of culture results, ciprofloxacin with or without rifampin, newer generation fluoroquinolones, or thirdgeneration cephalosporins with anti-pseudomonal activity such as ceftazidime are commonly used [1].…”

Section: Discussionmentioning

confidence: 99%

“…Courson et al [6] proposed that antibiotics should be given for at least 6 weeks if there is evidence of infection at the skull base. Bacterial culture and susceptibility testing provide the basis for antibiotic selection [5]. While EAC specimens can be sent for bacterial culture, results are often negative, and a bone biopsy may be necessary to guide antibiotic selection [5].…”

Section: Discussionmentioning

confidence: 99%

“…With advances in diagnosis and treatment, the mortality rate of MOE has decreased from 50 % to approximately 10 % [4]. Inadequate treatment, however, is common and associated with a high recurrence rate [1,5]. Because there are few reports of MOE in non-diabetic patients, we herein report a case of MOE in an otherwise healthy non-immunocompromised male to illustrate the problems encountered in the diagnosis and treatment of MOE.…”

Section: Introductionmentioning

confidence: 96%

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Malignant otitis externa in a healthy non-diabetic patient

Liu

Peng

et al. 2015

Eur Arch Otorhinolaryngol

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A healthy 60-year-old male was initially treated for external otitis, and subsequently received multiple surgeries including abscess drainage, temporal bone debridement, canaloplasty of the external auditory meatus, and fistula excision and was treated with numerous antibiotics at another hospital over a 1-year period. He was seen at our hospital on February 14, 2014 with a complaint of a non-healing wound behind the left ear and drainage of purulent fluid. He had no history of diabetes mellitus or compromised immune function. Computed tomography (CT) and magnetic resonance imaging (MRI) studies at our hospital showed osteomyelitis involving the left temporal, occipital, and sphenoid bones, the mandible, and an epidural abscess. Routine blood testing and tests of immune function were normal, and no evidence of other infectious processes was found. He was diagnosed with malignant otitis externa (MOE). Bone debridement and incision and drainage of the epidural abscess were performed, and vancomycin was administered because culture results revealed Corynebacterium jeikeium, Corynebacterium xerosis, and Enterococcus faecalis. MOE should be considered in healthy patients with external otitis who fail initial treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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Malignant otitis externa in a healthy non-diabetic patient

Liu

Peng

et al. 2015

Eur Arch Otorhinolaryngol

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“…Prompt intravenous antibiotic treatment is required until there is resolution of symptoms and return of the EAC to normal [2].The diagnosis is based on a combination of clinical, laboratory and image findings. With absence of single definite diagnostic criteria, the diagnosis is often delayed [1].…”

Section: Introductionmentioning

confidence: 99%

“…Necrotizing otitis externa (NOE), also called malignant otitis externa, corresponds to osteomyelitis of the skull base [1]. NOE occurs primarily in diabetic elderly patients with a male preponderance [2].…”

Section: Introductionmentioning

confidence: 99%

Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) of the Skull in Necrotizing Otitis Externa: Comparison with Planar Bone Scintigraphy, SPECT and CT

Yeddes¹

2017

JOENTR

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Purpose: Assess the diagnostic performance of single photon emission tomography/computed tomography (SPECT/CT) for identifying necrotizing otitis externa (NOE) and compare this technique with planar bone scintigraphy (BS), SPECT and CT. Methods:Data from 13 patients with suspected NOE were retrospectively studied. Planar BS and SPECT images were interpreted by nuclear medicine physician, CT images by radiologist and SPECT/CT images by both nuclear medicine physician and radiologist. Planar BS, SPECT and SPECT/CT images were taken as positive in the presence of increased skull base uptake and CT images in the presence of periosteal reaction and bone lysis. Clinical evolution, imaging results, microbiology and histopathology were taken into consideration to determine the final diagnosis. Sensitivity, specificity, and predictive values, were calculated for each technique. The McNemar's test chi-squared with Yates correction of 0.5 was used to compare sensitivities and specificities.Results: SPECT/CT had the highest sensitivity (100%), followed by SPECT (90%), planar BS (80%) and CT (60%). Specificity was 100% for all imaging modalities since all reported positive cases were identified as NOE in the final diagnosis. No statistically significant difference was noted when comparing SPECT/CT with planar BS, SPECT and CT. However, borderline statistical significance was found between SPECT/CT and CT (p-value=0.08). SPECT/CT was the best imaging modalities in the accurate location of sites of osteomyelitis. Conclusion:SPECT/CT showed high sensitivity and specificity in the diagnosis of NOE, but was not statistically superior to planar BS, CT or SPECT in this small patient population. Keywords:

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Cervical internal carotid Artery pseudoaneurysm complicating malignant otitis externa: First case report

et al. 2014

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Pseudoaneurysm of the internal carotid artery (ICA) is a rare complication of head and neck infections. To date, three cases of petrous ICA pseudoaneurysm have been described as a complication of otogenic infection, including only one secondary to malignant otitis externa. We present here the first case of cervical ICA pseudoaneurysm as a complication of malignant otitis externa, and stress the importance of timely diagnosis to avoid fatal outcomes.

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Initial management of necrotizing external otitis: Errors to avoid

Abstract: The practice audit constantly revealed delayed management of MOE, often resulting in inappropriate antibiotic prescriptions. Publication of practice guidelines for primary and secondary care practitioners therefore appears to be essential.

Cited by 27 publications

References 24 publications

Malignant otitis externa in a healthy non-diabetic patient

Malignant otitis externa in a healthy non-diabetic patient

Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) of the Skull in Necrotizing Otitis Externa: Comparison with Planar Bone Scintigraphy, SPECT and CT

Cervical internal carotid Artery pseudoaneurysm complicating malignant otitis externa: First case report

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