Malignant Otitis Externa: Causes for Various Treatment Responses

Arsović, Nenad; Radivojevic, Nemanja; Jesić, S; Babac, Snežana; Čvorović, Ljiljana; Dudvarski, Zoran

doi:10.5152/iao.2020.7709

Cited by 34 publications

(39 citation statements)

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“… 16 17 Previous studies have reported isolated VII or VIII CN palsy which may be because of inclusion of patients with malignant otitis externa. 18 On the contrary, in our cohort, majority had atypical SBO (80%) with no obvious clinical foci of infection elsewhere. Venous thrombosis is said to be more commonly associated with SBO, but we did not encounter any such patient.…”

Section: Discussioncontrasting

confidence: 56%

Predicting Outcome in Skull Base Osteomyelitis: An Assessment of Demographic, Clinical, and Pathological Attributes

Saxena

Paul

Singh

et al. 2021

JNRP

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Objective Skull base osteomyelitis (SBO) is an enigmatic clinical diagnosis which is difficult to decipher and is associated with poor outcomes. The study aims to examine the demographic and clinical characteristics of patients with SBO and its outcomes. Materials and Methods Medical records of 30 patients with diagnosis of SBO over past 5 years were assessed for demographic and clinical characteristics, type of SBO, radiological parameters, treatment received, procedure performed, microbiological profile, comorbidities, and complications including cranial nerve (CN) palsies. These factors were analyzed for prediction of outcome (death or survival). Statistical Analysis Microsoft Office Excel 2010 SAS 10.0 for Windows was used. Student's t-test for continuous variables (age, duration of symptoms, number of days of hospitalization, and treatment duration) and chi-square test for categorical variables (imaging findings, symptomatology, presence of comorbidities, surgical procedure, complications, and type of antibiotics) were utilized. Results We found SBO was the disease of elderly population (64.07 ± 6.13 years) with male predominance (83.3%) highly associated with uncontrolled diabetes status (93.3%). Headache (100%) and CN palsy (80%) were the most common neurological presenting complaints followed by stroke (17%) and encephalopathy (10%). Pathological and radiological correlation showed that fungal infection (Aspergillus) was associated with anterior SBO (10%), while bacteria (Pseudomonas) was cultured from posterior SBO (30%). Fifty per cent of patients were alive after 1 year out of which 33% had good functional outcome. The mortality rate was 33.3% in our cohort and multiple lower CN palsies (p = 0.04), suboptimal duration of medical treatment (p = 0.03), surgical intervention during clinical course (p = 0.02), and development of intracranial or extracranial complications (p = 0.03) were the predictors of mortality. Conclusion Early diagnosis including identification of pathogenic organisms and optimal duration of treatment are crucial factors for improved outcomes in SBO.

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Section: Discussioncontrasting

confidence: 56%

Predicting Outcome in Skull Base Osteomyelitis: An Assessment of Demographic, Clinical, and Pathological Attributes

Saxena

Paul

Singh

et al. 2021

JNRP

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“…The agents are bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella and Proteus mirabilis or fungal agents such as Aspergillus and Candida . However, Pseudomonas aeruginosa is the leading pathogen especially in immunocompromised patients with comorbidities such as diabetes, HIV and hematological diseases 5 , 10 . The most common microorganism in the culture samples taken from the external auditory canal of the patients was Pseudomonas aeruginosa in accordance with literature 10 , 11 .…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the best imaging modality for diagnosing and assessing the treatment response in MOE has been a point of concern regarding the accuracy and cost-effectiveness 5 .…”

Section: Introductionmentioning

confidence: 99%

Malignant Otitis Externa: How to Monitor the Disease in Outcome Estimation?

Yiğider¹,

Övünç²,

Arslan³

et al. 2021

MMJ

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Objective: Malignant otitis externa (MOE) is a serious disease affecting mainly the elderly diabetic patients that may result in mortality. It was aimed to evaluate the relationship between treatment responses and clinical and radiologic parameters among progress of the disease. Secondary aim was to present our clinical outcomes in the treatment of malignant otitis externa. Method: This study was retrospectively conducted in a single center. Reviewed data included history of complaints, duration of symptoms, addition of hyperbaric oxygen treatment, presence of surgical intervention, pathological findings, culture positivity and microorganism, laboratory findings, scintigraphy, imaging modalities and outcome of disease. Result: A total of 26 cases with malignant external otitis including 17 females (65.4%) and nine males (34.6%) patients were included in our study. Duration of symptoms before the initiation of treatment, and hyperbaric oxygen treatment did not positively influence the outcome. Inflammatory markers and Peleg staging significantly reflected the treatment response. Conclusion: Close monitoring of inflammatory parameters is the key point in the prediction of prognosis. Planning the management and predicting the outcomes rely on proper radiological and clinical assessment of the extent of disease. In the assessment of MOE, universal scoring systems should be preferred for pooling the data in comparable manner.

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“…En pacientes con factores predisponentes como la diabetes descompensada o inmunosupresión por VIH, la otitis externa puede presentarse más agresivamente, denominándose otitis externa maligna 45,46 . Esta es una infección grave causada principalmente por Pseudomona aeruginosa, que puede extenderse al hueso temporal cortical, pudiendo afectar la apófisis mastoidea, el ápex petroso y causar osteomielitis de base de cráneo.…”

Section: Otitis Externaunclassified

“…Esta es una infección grave causada principalmente por Pseudomona aeruginosa, que puede extenderse al hueso temporal cortical, pudiendo afectar la apófisis mastoidea, el ápex petroso y causar osteomielitis de base de cráneo. Se presenta con otalgia intensa, que no cede con la analgesia, otorrea, generalmente sin fiebre, y puede evolucionar con compromiso de pares craneanos 46 . El abordaje quirúrgico con debridamiento de los tejidos infectados es parte importante de la terapia y deben tomarse tinciones como cultivos para identificación microbiológica y la mejor elección de los antibióticos.…”

Section: Otitis Externaunclassified