Occult middle ear and mastoid fluid in acute otitis externa

Brennan, Tara E.; Saadia‐Redleaf, Miriam I.

doi:10.1002/lary.23414

Cited by 7 publications

(6 citation statements)

References 2 publications

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“…In our series, whenever the tympanic membrane could be visualized, it was seen to be pulsatile. This finding is in keeping with an earlier study that 80% of simple otitis externa cases have fluid in the middle ear or mastoid 13 —all the more reason to be vigilant in otitis externa in an immunocompromised person 8 since these fluid-filled middle ear and mastoid air cell spaces can lead to worsening clinical pictures.…”

Section: Discussionsupporting

confidence: 90%

Effective Inexpensive Management of Necrotizing Otitis Externa Is Possible in Resource-Poor Settings

Vijayendra¹,

Ramdass²,

Mahajan³

et al. 2019

Ann Otol Rhinol Laryngol

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Introduction: Necrotizing otitis externa resolves best with antimicrobial treatment. How to care for these patients and monitor their resolution remains a problem. Our protocol in Bangalore can manage these patients inexpensively and well. Materials and Methods: Patients who were referred to our patients became the subjects for this paper. They were managed through our protocol, which consists of IV ciprofloxacin and meropenem, weekly labs, weekly examinations, and photodocumention. Results: Fifty-one people presented with necrotizing otitis externa (NOE) between October 2015 and November 2017 and completed our entire protocol. Forty-six had complete resolution of their disease, while 5 had to undergo surgical removal of necrotic bone. Six of 8 patients with facial weakness had improvement in their House-Brackmann scores. Reduction of self-reported nocturnal pain, dissolution of ear canal granulations, and normalization of the erythrocyte sedimentation rate (ESR) proved to be the most accurate indicators of disease regression. Conclusion: Patients are monitored closely with review of their otalgia, examination of their canal, repeated ESRs, effective control of their diabetes, and radiological imaging. All this can be done in a resource-poor country, which in turn serves as a model for the wealthier nations.

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Section: Discussionsupporting

confidence: 90%

Effective Inexpensive Management of Necrotizing Otitis Externa Is Possible in Resource-Poor Settings

Vijayendra¹,

Ramdass²,

Mahajan³

et al. 2019

Ann Otol Rhinol Laryngol

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“…Fluid may be present in the middle ear or mastoid in patients with AOE. 88 Patients with concurrent AOM and AOE may require systemic antibiotic therapy. As discussed later in the guideline, clinicians should recommend a non-ototoxic topical preparation when the tympanic membrane is not intact.…”

Section: Supporting Textmentioning

confidence: 99%

“…Patients with AOE may also develop AOM without perforation of the tympanic membrane independent of AOE. Fluid may be present in the middle ear or mastoid in patients with AOE 88 . Patients with concurrent AOM and AOE may require systemic antibiotic therapy.…”

Section: Guideline Key Action Statementsmentioning

confidence: 99%

Clinical Practice Guideline: Acute Otitis Externa

Rosenfeld

Schwartz

Cannon

et al. 2014

Otolaryngol.--head neck surg.

133

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Objective. This clinical practice guideline is an update and replacement for an earlier guideline published in 2006 by the American Academy of Otolaryngology-Head and Neck Surgery Foundation. This update provides evidence-based recommendations to manage acute otitis externa (AOE), defined as diffuse inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. The variations in management of AOE and the importance of accurate diagnosis suggest a need for updating the clinical practice guideline. The primary outcome considered in this guideline is clinical resolution of AOE.Purpose. The primary purpose of the original guideline was to promote appropriate use of oral and topical antimicrobials for AOE and to highlight the need for adequate pain relief. An updated guideline is needed because of new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. The target patient is aged 2 years or older with diffuse AOE. Differential diagnosis will be discussed, but recommendations for management will be limited to diffuse AOE, which is almost exclusively a bacterial infection. This guideline is intended for primary care and specialist clinicians, including otolaryngologists-head and neck surgeons, pediatricians, family physicians, emergency physicians, internists, nurse practitioners, and physician assistants. This guideline is applicable in any setting in which patients with diffuse AOE would be identified, monitored, or managed.Action Statements. The development group made strong recommendations that (1) clinicians should assess patients with AOE for pain and recommend analgesic treatment based on the severity of pain and (2) clinicians should not prescribe systemic antimicrobials as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy. The development group made recommendations that (1) clinicians should distinguish diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the external ear canal; (2) clinicians should assess the patient with diffuse AOE for factors that modify management (nonintact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, prior radiotherapy); (3) clinicians should prescribe topical preparations for initial therapy of diffuse, uncomplicated AOE; (4) clinicians should enhance the delivery of topical drops by informing the patient how to administer topical drops and by performing aural toilet, placing a wick, or both, when the ear canal is obstructed; (5) clinicians should prescribe a non-ototoxic preparation when the patient has a known or suspected perforation of the tympanic membrane, including a tympanostomy tube; and (6) clinicians should reassess the patient who fails to respond to the initial therapeutic option within 48 to 72 hours to confirm the diagnosis of diffuse AOE and to exclude other causes of illness. Keyw...

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“…As sample size was a significant covariate, it is likely that variation in the characteristics of the sampled populations played a role in the prevalence of mastoid opacification. Mastoid opacification has been demonstrated in eustachian tube dysfunction, 21,32 glue ear and other middle ear disease, 12,21,23,32 intensive care unit patients, 37 upper respiratory tract infections, 29 and otitis externa 38 . Therefore, varying rates of these conditions in the study samples may explain the significance of sample size.…”

Section: Discussionmentioning

confidence: 98%

“…Mastoid opacification has been demonstrated in eustachian tube dysfunction, 21,32 glue ear and other middle ear disease, 12,21,23,32 intensive care unit patients, 37 upper respiratory tract infections, 29 and otitis externa. 38 Therefore, varying rates of these conditions in the study samples may explain the significance of sample size. Studies with larger samples also tended to utilize the less labor-intensive methodology of screening radiology reports to identify mastoid opacification, whereas smaller studies were more likely to use direct interpretation of images, which exerts an effect, as already discussed.…”

Section: Overall Completeness and Applicabilitymentioning

confidence: 99%

The Prevalence of Incidental Mastoid Opacification and the Need for Intervention: A Meta‐Analysis

2021

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Objectives/Hypothesis: The increasing use of cross-sectional imaging has led to the predicament of incidental mastoid opacification (IMO). We investigated the prevalence of IMO and the clinical need for ENT assessment or intervention when identified.Study Design: Systematic review and meta-analysis. Methods: The PRISMA statement standards were used to search electronic databases including Medline, Embase, PubMed, and Web of Science. The selection criteria were mastoid opacification found on computed tomography (CT) or magnetic resonance imaging (MRI) as incidental findings.Results: A total of 16 studies were identified for qualitative analysis and 15 for quantitative analysis, mainly retrospective. The pooled prevalence of IMO in 246,288 patients was 8.4% (95% CI 5.5-12.0). The prevalence of IMO was significantly higher in studies with children (17.2%, 95% CI 10.9-24.6) than those with adults (6.1%, 95% CI 3.3-9.6); smaller sample size studies (12.4%, 95% CI 8.1-17.3) compared to larger sample size studies (4.1%, 95% CI 1.5-7.8); and when IMO was detected by viewing images (14.5%, 95% CI 9.9-19.8) compared to reading reports (3.5%, 95% CI 1.3-6.6). Imaging modality was not a significant moderator due to similar IMO rate on CT (8.6%, 95% CI 1.8-19.7) and MRI (10.4%, 95% CI 4.9-17.6). Nine studies reported on clinical outcomes of patients with IMO, and none reliably reported any cases of clinical mastoiditis.Conclusions: The term "mastoiditis" on radiology reports based on IMO does not indicate a clinical diagnosis of mastoiditis, although the current body of evidence is limited. Otolaryngology review is suggested if clinical correlation detects otological signs or symptoms.

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Occult middle ear and mastoid fluid in acute otitis externa

Abstract: These findings support our hypothesis and serve to inform the medical community (both ENT and primary care) that fluid is often present in the ME or mastoid in patients with acute OE whose symptoms will resolve with oral and/or topical antibiotics.

Cited by 7 publications

References 2 publications

Effective Inexpensive Management of Necrotizing Otitis Externa Is Possible in Resource-Poor Settings

Effective Inexpensive Management of Necrotizing Otitis Externa Is Possible in Resource-Poor Settings

Clinical Practice Guideline: Acute Otitis Externa

The Prevalence of Incidental Mastoid Opacification and the Need for Intervention: A Meta‐Analysis

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