Necrotizing otitis externa: diagnosis, treatment, and outcome in a case series

Glikson, Eran; Sagiv, Doron; Wolf, Michael; Shapira, Yehoshua

doi:10.1016/j.diagmicrobio.2016.10.017

Cited by 40 publications

(49 citation statements)

References 18 publications

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“…Also, CT and MRI abnormalities persist despite the resolution of the disease, and so are not useful for therapeutic monitoring in SBO . Bone remineralization after disease resolution is a late phenomenon making CT not reliable for early therapeutical management . On MRI, soft tissue abnormalities also persist after the resolution of the disease, as well as bone marrow abnormal signals that persist from 6 to 12 months after successful treatment …”

Section: Discussionmentioning

confidence: 99%

“…7,8 Bone remineralization after disease resolution is a late phenomenon making CT not reliable for early therapeutical management. 9,11,18 On MRI, soft tissue abnormalities also persist after the resolution of the disease, as well as bone marrow abnormal signals that persist from 6 to 12 months after successful treatment. 16,[18][19][20] Bone scintigraphy allows earlier diagnosis of SBO than CT, with a sensitivity of almost 100%.…”

Section: Discussionmentioning

confidence: 99%

“…Various studies on SBO highlighted the need for a sensitive and specific technique that could help physician to affirm healing in order to adapt case by case the duration of antibiotherapy . The persistence of MRI and CT abnormalities after treatment despite resolution of the disease makes these techniques unreliable . Bone scintigraphy (HMDP‐Tc‐99m) has the same limitations .…”

Section: Introductionmentioning

confidence: 99%

“…6 The persistence of MRI and CT abnormalities after treatment despite resolution of the disease makes these techniques unreliable. [7][8][9][10][11] Bone scintigraphy (HMDP-Tc-99m) has the same limitations. 9 Leukocyte scintigraphy (LS) is known to specifically detect bacterial infections, but very few data are available regarding LS in SBO.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9][10][11] Bone scintigraphy (HMDP-Tc-99m) has the same limitations. 9 Leukocyte scintigraphy (LS) is known to specifically detect bacterial infections, but very few data are available regarding LS in SBO. 12,13 The aim of this study was to evaluate LS in SBO patients as a tool for the initial diagnosis and to confirm healing after antibiotherapy.…”

Section: Introductionmentioning

confidence: 99%

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^99mTc‐HMPAO‐leukocyte scintigraphy for diagnosis and therapy monitoring of skull base osteomyelitis

Rozenblum

Vérillaud

Paycha

et al. 2018

Laryngoscope Investig Oto

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ObjectiveSkull base osteomyelitis (SBO) is a rare but life‐threatening disease observed in elderly diabetic patients, with high risk of recurrence and difficult therapeutic management. The diagnosis is ascertained from a set of clinical, biological, and imaging findings. CT and MRI allow initial diagnosis, but are not accurate to affirm healing at the end of therapy. 99mTc‐HMPAO‐Leucocyte Scintigraphy (LS) is highly sensitive and specific for the detection of infection. The aim of this study was to evaluate LS i) for initial diagnosis, and ii) to confirm healing at the end of antibiotherapy in SBO.Study designWe retrospectively reviewed from November 2011 to September 2015 all patients with confirmed SBO who underwent LS twice, at diagnosis and at the end of antibiotic therapy in our nuclear medicine department (n = 27).MethodsClinical, biological, CT, LS, and follow‐up data were recorded in all patients. LS images (planar and tomographic performed 4 hours and 24 hours after intravenous injection of autologous Tc‐99m‐HMPAO‐leucocytes) were visually assessed and quantified.ResultsAt initial diagnosis, 25 of 27 patients had a positive LS. At the end of antibiotic therapy (3 ± 1 months duration), 26 of 27 patients had a negative LS. During subsequent follow‐up (= or >6 months), the disease recurred in four patients including three with a negative postantibiotherapy LS scan.ConclusionIn this retrospective study, LS was powerful for initial diagnostic of SBO and for healing assessment at the end of antibiotic therapy. We conclude it is a useful technique for therapeutic monitoring of SBO.Level of Evidence4

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

^99mTc‐HMPAO‐leukocyte scintigraphy for diagnosis and therapy monitoring of skull base osteomyelitis

Rozenblum

Vérillaud

Paycha

et al. 2018

Laryngoscope Investig Oto

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Skull base osteomyelitis in patients with head and neck cancer: Diagnosis, management, and outcomes in a case series of 23 patients

Czech

Hwang

Colevas

et al. 2022

Laryngoscope Investig Oto

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Background: Skull base osteomyelitis (SBO) is an infection of the central cranial bones, most commonly resulting from contiguous spread of infection from adjacent head and neck structures. SBO is a well-recognized complication of treatment of head and neck cancer (HNC) that results in significant morbidity. Methods:We conducted a retrospective chart review of HNC patients diagnosed with SBO.Results: SBO was commonly diagnosed with nasal endoscopy showing mucosal breakdown between the naso/oropharynx and skull base and with characteristic changes on CT/MRI. Culture data were often polymicrobial, inclusive of naso/ oropharyngeal flora, but half of the patients additionally had antibiotic-resistant or atypical pathogens. The mean duration of antimicrobial therapy was 117 +/À 94 days. Recurrent SBO was found in half of the patients, associated with Pseudomonas aeruginosa and with persistent defects in the mucosa abutting the skull base.Conclusions: Diagnosis and management of SBO in HNC patients are challenging.Recommendations to aid in clinical care are proposed.Level of evidence: 4, case series.head and neck cancer, nasopharyngeal carcinoma, osteoradionecrosis, skull base osteomyelitis | INTRODUCTIONSkull base osteomyelitis (SBO) is an infection of the central cranial bones, involving parts of the sphenoid, occipital, and/or temporal bones. These infections most commonly result from contiguous extension of infection from the ear, paranasal sinuses, and/or nasooropharyngeal cavity. 1,2 SBO is classically and most commonly described in patients with uncontrolled diabetes who have otitis externa complicated by temporal bone osteomyelitis with extension into the central skull base. 3,4 However, SBO is increasingly being described in other patient populations.Our clinical experience demonstrates a significant number of SBO cases occurring in patients with head and neck cancer (HNC), though there are only limited case reports describing SBO in HNC patients. 5,6 Patients with HNC have underlying anatomic abnormalities resulting from tumor destruction, surgical intervention(s), and/or

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