Malignant external otitis: utility of CT in diagnosis and follow-up.

Abstract

Malignant external otitis is a severe bacterial infection of the bone and soft tissues of the base of the skull that is frequently difficult to diagnose. The effectiveness of antibiotic therapy is likewise difficult to assess. Serial computed tomographic (CT) scans were obtained in 11 consecutive patients with malignant external otitis at time of diagnosis and periodically after conclusion of antibiotic therapy. All patients demonstrated abnormalities of the external auditory canal, with or without bone destruction. Soft tissue or fluid in the middle ear and mastoid, around the eustachian tube, and in the parapharyngeal space (both pre- and poststyloid) was seen in greater than 50% of the cases. While remineralization of bone was not seen, soft-tissue disease improved dramatically, and recurrence or persistence could be corroborated by detection of more extensive soft-tissue changes. By delineating the extra- and intracranial extent of disease, serial CT scans enable one to make the diagnosis, determine the extent of infection, document recurrence, exclude progression, and confirm resolution of malignant external otitis.

Clinical Challenges in the Diagnosis and Treatment of Temporal Bone Osteomyelitis

“…Later, the erosive changes in the different parts of the temporal bone, temporomandibular joint, and mandibular fossa were clearly delineated on CT scans. Our findings are in agreement with the results of previous investigators [9, 10]. However, a computed tomography is limited in use for monitoring the response to treatment because demineralization changes are detected even in the beginning of disease and persist despite resolution of the clinical symptoms [2, 11].…”

Necrotizing External Otitis in Patients with AIDS

“…Staging was determined by clinical evaluation as well as demonstration of the extent of soft tissue and bony involvement by HRCT in a manner previously described by Rubin et al 14 HRCTs on all seven patients were reviewed by a single neuroradiologist who was blinded to the clinical severity of disease and its course. The anatomical structures and spaces specifically evaluated on the HRCT review were 1) EAC abnormality, 2) masticator space involvement; 3) mastoid or middle ear soft tissue involvement; 4) parapharyngeal space extension; 5) infratemporal extension; 6) temporal bone erosion; 7) mass effect on the nasopharynx; 8) extension across the midline; 9) disease around the eustachian tube; 10) clivus erosion; and 11) intracranial extension.…”

Malignant External Otitis: Review and Personal Experience

“…It can reveal inflammatory changes in the soft tissues of the tympanic cavity and mastoid, infratemporal fossa, parapharyngeal space, and nasopharynx, as well as in the area of the stylomastoid foramen, where facial nerve involvement most frequently occurs (42,(44)(45)(46).…”