Recurrent malignant otitis externa with multiple cranial nerve involvement: A case report

Djerić, D; Folić, Miljan; Janicijevic, M Aleksandar; Blažić, Srbislav; Popadić, Danka

doi:10.2298/sarh1606315d

Cited by 2 publications

(13 citation statements)

References 20 publications

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“…SBO is also predominantly seen in older patients [8, 10, 15, 17, 21]. In our study, most of the patients were over 60 years.…”

Section: Discussionmentioning

confidence: 48%

“…Frequent symptom in malignant otitis externa is severe otalgia accompanied by purulent otorrhea [8, 10, 11, 15, 17, 21] found in three patients (42.86%); however, otitis and/or otorrhea was found in 85.71% of analyzed cases in this study. On physical examination, the typical finding is granulation tissue/polyp located in the EAC at the level of bony–cartilaginous junction [15, 17, 21] that was found in one patient. In our study, the pathologic changes in the EAC were found in four cases with perforation of the tympanic membrane in three of them.…”

Section: Discussionmentioning

confidence: 53%

“…Skull base osteomyelitis is a complex clinical entity and remains a great challenge due to rarity of the condition, however, with increasing prevalence, not fully analyzed prognostic factors and high mortality rate [3–5, 8, 11, 12, 15, 16]. Diagnosis of the disease is difficult, because there is no single pathognomonic criterion that defines malignant otitis externa and skull base inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have described facial nerve dysfunction and other CN involvement in skull base osteomyelitis. The occurrence of CN paresis indicates progression of the disease [4, 8, 11, 14, 15, 21]. Furthermore, patients with any CN involvement experience usually worse outcomes; in some of them, the neurological deficits do not resolve completely [4, 8, 18, 21, 22].…”

Section: Discussionmentioning

confidence: 99%

“…The prognosis in skull base osteomyelitis is serious with the possibility of recurrence, which results in subsequent hospitalizations and high mortality rate [12, 13]. CN paresis always indicates serious complication and is often associated with deterioration of the prognosis for recovery [4, 11, 14, 15].…”

Section: Introductionmentioning

confidence: 99%

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Skull base osteomyelitis: factors implicating clinical outcome

et al. 2019

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Skull base osteomyelitis is a serious disease with a high risk of complications including neuroinfection. Typically, the inflammation of the skull base results from infection from neighboring tissues. In case of malignant otitis externa, inflammation disseminates from the external auditory canal. In this study, we present our experience with seven patients diagnosed with skull base osteomyelitis that began with otitis externa and have been treated in our department for the last 10 years. Department Patient Database was searched for the diagnosis skull base osteomyelitis. The search covered the last 10 years. The search revealed seven patients who met the above-described criteria. Medical records of those patients were carefully analyzed including age, gender, symptoms and signs, diagnostics details, treatment, performed procedures, number of hospitalization days, comorbid diseases, and complications including any cranial nerve palsy. Detailed analysis of medical records of patients included in this study showed that skull base osteomyelitis presents a challenge for diagnosis and treatment. Treatment strategy requires prolonged aggressive intravenous antibiotic therapy, and in some cases combined with surgical intervention. Cranial nerve paresis indicates progression of the disease and is associated with longer hospital stay. Similar relationship is observed in patients with skull base osteomyelitis that required surgery. Diabetes in patient’s medical history may complicate the healing process. Diabetes, neural involvement, and surgery may overlap each other resulting in longer hospital stay. Cranial nerve paresis may not resolve completely and some neural deficits become persistent.

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“…SBO is also predominantly seen in older patients [8, 10, 15, 17, 21]. In our study, most of the patients were over 60 years.…”

Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Skull base osteomyelitis: factors implicating clinical outcome

et al. 2019

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Necrotizing Otitis Externa: A Proposal for Diagnostic and Therapeutic Approach

Costa,

Onishi

2023

Int Arch Otorhinolaryngol

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Introduction Necrotizing otitis externa has a high impact on the quality of life of patients and has shown a significant increase in its incidence in recent years. There has been a change in the profile of affected patients and a lack of consensus on the management of these patients. Objective To develop a practical and effective care protocol to standardize the diagnostic and therapeutic management of necrotizing otitis externa. Methods A retrospective cohort study of necrotizing otitis externa patients between January 2015 and December 2020. Results There were 34 patients with two bilateral cases, totaling 36 ears. The mean age was 68.5, with a higher prevalence of males (76%). Diabetes was present in 97% of the samples. The involvement of cranial pairs was identified in 35% of the sample. Pseudomonas aeruginosa was the most frequent pathogen isolated, found in 50% of the cases. Among the cultures with bacterial agents isolated, 35% showed resistance to ciprofloxacin. The most frequent exam was computed tomography (94%). Hospital admission was indicated for 31 patients (91%), and ceftazidime was the most prescribed drug (35.5%). There were 11 recurrences (32%), and 12 patients (35%) had complications during treatment. Among the unfavorable outcomes, 12% persisted with some degree of peripheral facial paralysis, 6% maintained dysphagia, and 9% died of the disease. Conclusions The present study developed a diagnostic and therapeutic protocol for the effective management of necrotizing otitis externa. This protocol is a dynamic tool and should be revised and updated as new demands emerge during its implementation.

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Recurrent malignant otitis externa with multiple cranial nerve involvement: A case report

Cited by 2 publications

References 20 publications

Skull base osteomyelitis: factors implicating clinical outcome

Skull base osteomyelitis: factors implicating clinical outcome

Necrotizing Otitis Externa: A Proposal for Diagnostic and Therapeutic Approach

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