Malignant external otitis: Factors predicting patient outcomes

Shavit, Sagit Stern; Soudry, Ethan; Hamzany, Yaniv; Nageris, Ben I.

doi:10.1016/j.amjoto.2016.04.005

Cited by 73 publications

(93 citation statements)

References 22 publications

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“…Computed tomography scan is a useful diagnostic tool, and different grading systems were developed over the years in an effort to predict correlation with disease severity . A previous publication from our institution reported that any positive findings in a CT scan increase the risk for mortality by 4.5‐fold . Positive correlation was found by others as well .…”

Section: Discussionmentioning

confidence: 64%

“…Positive correlation was found by others as well . Neither Tc99m nor Ga67 scan findings were found to correlate with disease prognosis …”

Section: Discussionmentioning

confidence: 73%

“…As long as 30 years ago, the combination of these two tests was shown to be more sensitive and specific for diagnosing NEO than was any other available test . Since then, it has become the most common protocol used by many physicians worldwide . However, in several meta‐analyses both tests, separately or combined, were shown to have lower sensitivity and specificity than did 18F‐FDG‐PET/CT in diagnosing axial osteomyelitis .…”

Section: Discussionmentioning

confidence: 99%

“…Necrotizing (malignant) external otitis (NEO) is an aggressive infection with 14% disease‐specific mortality despite appropriate antibiotic treatment . The infection originates in the external ear canal and spreads to adjacent structures.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, consensus is lacking regarding the best imaging modality for initial diagnosis and follow‐up. Whereas positive findings on computed tomography (CT) scan have been proven a useful tool for diagnosis and prognosis prediction, its role in routine follow‐up is debatable. Suggestive features in CT scans such as bone erosion may take months to develop and are irreversible …”

Section: Introductionmentioning

confidence: 99%

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FDG‐PET/CT for diagnosis and follow‐up of necrotizing (malignant) external otitis

et al. 2018

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Objective Imaging is important for the diagnosis and follow‐up of necrotizing external otitis (NEO). The best imaging modality is controversy. To suggest 2‐deoxy‐2‐[fluorine‐18] fluoro‐D‐glucose‐positron emission tomography/computed tomography (18F‐FDG‐PET/CT) as an alternative to technetium‐99m and gallium‐67 scans for diagnosis and assessment of response to treatment for patients with NEO. Study Design Case series. Methods Tertiary referral center. From 2013 through 2017, 12 patients were diagnosed with NEO based on clinical features and positive FDG uptake within the temporal bone on PET/CT. Mean age was 74 ± 11.5; 83% of the patients were male; and 83% had diabetes. Results PET/CT scans were reviewed independently by two nuclear medicine specialists. Imaging located osteomyelitis in external ear canal, mastoid, temporomandibular joint, and nasopharyngeal region (100%, 50%, 16%, 8%, respectively). Mean follow‐up was 16 months. Eight patients (67%) underwent a second PET/CT scan after active otitis resolved and after at least 6 weeks of antibiotic treatment. The scan demonstrated no or substantially reduced FDG uptake and treatment was stopped. The patients had no NEO symptoms at the end of follow‐up. One patient had significant uptake, and antibiotic treatment was continued until a third scan demonstrated no FDG uptake. Two patients died before the second PET/CT, and two were lost to follow‐up. Conclusion 18F‐FDG‐PET/CT is a reliable imaging modality for diagnosis, disease localization, and decision making regarding treatment cessation. 18F‐FDG‐PET/CT should be considered as the imaging modality of choice for initial diagnosis and follow‐up in NEO patients. Larger, controlled studies are warranted. Level of Evidence 4 Laryngoscope, 129:961–966, 2019

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Section: Discussionmentioning

confidence: 64%

“…Positive correlation was found by others as well . Neither Tc99m nor Ga67 scan findings were found to correlate with disease prognosis …”

Section: Discussionmentioning

confidence: 73%