Invasive Fungal and Bacterial Infections of the Temporal Bone

Abstract

Invasive polymicrobial temporal bone infections can occur in immunocompromised patients and can possibly harbor an occult malignancy. Surgical debridement may be necessary to arrive at a correct diagnosis. Modified radical mastoidectomy with parenteral antibiotic therapy and other adjunctive measures may be necessary for disease resolution.

Gentamicin Ointment versus Petrolatum for Management of Auricular Wounds

“…If infection is suspected, cultures and sensitivities should be obtained and treatment initiated with a quinolone antibiotic, with future therapy directed by the culture results 11 . Destructive fungal infections of the ear are rare but should be suspected when infection does not improve clinically with antibiotics 15,16 …”

Fungal malignant otitis externa treated with hyperbaric oxygen

“…Fungal MOE is rare, and is most often due to A. fumigatus, but cases involving A. flavus and other species have also been reported. 2 Aspergillus are ubiquitous saprophytic moulds, commonly found on decaying material around the world. Aspergillus also produce a variety of compounds that can contribute to their pathogenicity, such as various proteases, aflatoxin, and phospholipases, and grow at a rapid rate when around 37 8C.…”

“…Fungal cases of MOE are rare, with the most common causative organism being Aspergillus fumigatus. In the reported cases of fungal MOE, 2,3 various management strategies were employed to treat the disease, with mixed outcomes. The following case is of MOE due to Aspergillus flavus, which was successfully treated with surgical debridement, aggressive antifungal agents, and hyperbaric oxygen therapy.…”

Gentamicin Ointment versus Petrolatum for Management of Auricular Wounds

“…11 Destructive fungal infections of the ear are rare but should be suspected when infection does not improve clinically with antibiotics. 15,16 It is reported that Mohs surgeons use prophylactic antibiotics in 77% of patients and often higher when procedures involved manipulation of auricular cartilage. 17,18 A 1996 cost savings analysis estimated that the United States would save 8 to 10 million dollars per year by dermatologists alone switching from topical antibiotics to petrolatum.…”