1
|
Suga Y, Watanabe N, Suzuki K, Koyama S, Taji Y, Hirano H, Hayashi T, Abe M, Miyazaki Y, Baba Y, Kurita H, Mitsutake K, Ebihara Y. Otitis externa caused by Malassezia slooffiae complicated with mastoiditis: A case report. J Infect Chemother 2023; 29:353-356. [PMID: 36522818 DOI: 10.1016/j.jiac.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
Herein, we report a case of otitis externa caused by Malassezia slooffiae complicated with mastoiditis. A 70-year-old male complained of fever and severe otorrhea from left external auditory canal 2 months after undergoing a craniotomy to remove a hematoma. He had right-sided paralysis and undertook bed rest. Brain computed tomography revealed continuous fluid accumulation in the left mastoid air cells and middle ear from left external auditory canal in addition to leukocytosis and increased C-reactive protein level. The tympanic membrane was severely swelling. These results indicated the presence of otitis media and mastoiditis. Otorrhea culture showed large amounts of M. slooffiae. The administration of liposomal amphotericin B (L-AMB), the irrigation of external auditory canal with normal saline, and the application of topical ketoconazole ointment were started. The administration of L-AMB for 8 weeks and voriconazole, which was switched from L-AMB, for 4 weeks ameliorated his infection and he was transferred to another hospital to receive rehabilitation. From these results and his clinical course, the diagnosis of otitis externa caused by Malassezia slooffiae complicated with mastoiditis was made. And the possibility of the contamination by M. slooffiae was very low. Clinicians should be aware that M.slooffiae can provoke otological infections since M. slooffiae is the most common Malassezia sp. in external auditory canal.
Collapse
Affiliation(s)
- Yuto Suga
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, Japan
| | - Noriyuki Watanabe
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kaima Suzuki
- Department of Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Sachie Koyama
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yoshitada Taji
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiroto Hirano
- Department of Head and Neck Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takahiro Hayashi
- Department of Head and Neck Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masahiro Abe
- Department of Fungal Infection, National Institute of Infectious Disease, Tokyo, Japan
| | - Yoshitsugu Miyazaki
- Department of Fungal Infection, National Institute of Infectious Disease, Tokyo, Japan
| | - Yasutaka Baba
- Department of Diagnostic Imaging, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiroki Kurita
- Department of Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kotaro Mitsutake
- Department of Infectious Diseases and Infection, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasuhiro Ebihara
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, Japan; Department of Laboratory Medicine, Saitama Medical University International Medical Center, Saitama, Japan.
| |
Collapse
|
2
|
McQueen A, Al-Zuhir N, Ali T. Incidentalomas in the head & neck. Br J Radiol 2023; 96:20220164. [PMID: 36317814 PMCID: PMC9975523 DOI: 10.1259/bjr.20220164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022] Open
Abstract
Incidental findings (IFs) in the head & neck are a frequent challenge to the reporting radiologist. A combination of complex anatomy, widely varied imaging techniques and the high prevalence of benign pathology, makes safe and appropriate management of head & neck IFs problematic. The non-head & neck radiologist is unlikely to have prior personal experience of the relevant specialties or current involvement with the pertinent multidisciplinary teams, creating unfamiliarity with both the clinical aspects of head & neck disease and the value of examination techniques. This triumvirate of complex anatomy, pathology and imaging creates the perfect environment for excessive investigation and overdiagnosis. In this article, the most frequently encountered and clinically relevant head & neck IFs are summarised. To reflect daily clinical practice, we will firstly consider anatomic abnormalities identified on cross-sectional imaging and ultrasound, followed by a review of PET-CT incidental findings.
Collapse
Affiliation(s)
- Andrew McQueen
- Department of Radiology, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Naail Al-Zuhir
- Department of Radiology, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Tamir Ali
- Department of Radiology, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
3
|
Alexandru M, de Boissieu P, Benoudiba F, Moustarhfir M, Kim S, Bequignon É, Honoré I, Garcia G, Mitri-Frangieh R, Legendre M, Crestani B, Taillé C, Escudier E, Maitre B, Papon JF, Nevoux J. Otological Manifestations in Adults with Primary Ciliary Dyskinesia: A Controlled Radio-Clinical Study. J Clin Med 2022; 11:jcm11175163. [PMID: 36079093 PMCID: PMC9456589 DOI: 10.3390/jcm11175163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 12/05/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetical disease characterized by an abnormal structure or function of the cilia, causing sinusitis, otitis, and bronchiectasis. Hearing loss affects 60% of PCD patients, but data are lacking concerning hearing and temporal bone imaging in adults. Our aim was to describe clinical and radiological ear disease in adults with genetically confirmed PCD. Data were recorded from January 2018 to December 2019. PCD patients were compared with controls with bronchiectasis without PCD. Clinical examination included otomicroscopy and auditory tests. A temporal bone CT scan (TBCT) was systematically performed. Seventeen patients (34 ears) were included in each group. The eardrums were abnormal in 25 (74%) PCD ears versus 8 (24%) ears in the controls (p < 0.05). Conductive hearing loss was more frequent in the PCD group (24% vs. 12% in controls). TBCT were abnormal in 94% PCD patients vs. 32% in the controls (p < 0.05). The Main CT-scan images in PCD were middle ear inflammation (65%), mastoid condensation (62%), or ossicular anomalies (35%). With its excellent sensitivity, TBCT gives typical arguments for PCD diagnosis, adding otological signs to the usual sinus CT signs (hypoplasia, aplasia). Systematic TBCT could be useful in the initial evaluation of patients with suspicion of PCD.
Collapse
Affiliation(s)
- Mihaela Alexandru
- ENT Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
- Correspondence: ; Tel.: +33-145-213-688
| | - Paul de Boissieu
- Epidemiology and Public Health Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
| | - Farida Benoudiba
- Diagnostic Neuroradiology Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
| | - Malik Moustarhfir
- Diagnostic Neuroradiology Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
| | - Sookyung Kim
- ENT Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
| | - Émilie Bequignon
- ENT Department, Henri Mondor Hospital, Intercommuncal Hospital of Créteil, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Est University, 94010 Créteil, France
- Mondor Institute of Biomedical Research INSERM-UPEC UMR 955, CNRS ERL7000, 94010 Créteil, France
| | - Isabelle Honoré
- Pneumology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 75014 Paris, France
| | - Gilles Garcia
- Pneumology Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
| | - Rana Mitri-Frangieh
- Department of Anatomy and Cytology Pathology, Intercommuncal Hospital of Créteil, 94010 Créteil, France
| | - Marie Legendre
- Molecular Genetics Functional Unit, Armand-Trousseau Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75012 Paris, France
- INSERM, UMR-S933 Genetic Diseases of Pediatric Expression, Sorbonne University, 75005 Paris, France
| | - Bruno Crestani
- Rare Pulmonary Diseases (FHU APOLLO) Pneumology A Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 75877 Paris, France
- Laboratory of Excellence Inflamex, 75013 Paris, France
- INSERM U1152, Paris Cité University, 75018 Paris, France
| | - Camille Taillé
- Rare Pulmonary Diseases (FHU APOLLO) Pneumology A Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 75877 Paris, France
- INSERM U1152, Paris Cité University, 75018 Paris, France
- INSERM 12, F-CRIN, Clinical Research Initiative in Severe Asthma: A Lever for Innovation & Science (CRISALIS), 31059 Toulouse, France
| | - Estelle Escudier
- Molecular Genetics Functional Unit, Armand-Trousseau Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75012 Paris, France
- INSERM, UMR-S933 Genetic Diseases of Pediatric Expression, Sorbonne University, 75005 Paris, France
| | - Bernard Maitre
- Mondor Institute of Biomedical Research INSERM-UPEC UMR 955, CNRS ERL7000, 94010 Créteil, France
- Pneumology Department, Henri Mondor Hospital, Intercommuncal Hospital of Créteil, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Est University, 94010 Créteil, France
| | - Jean-François Papon
- ENT Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
- Mondor Institute of Biomedical Research INSERM-UPEC UMR 955, CNRS ERL7000, 94010 Créteil, France
| | - Jérôme Nevoux
- ENT Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
- INSERM, U1120, Pasteur Institute, 75724 Paris, France
| |
Collapse
|
4
|
Moonis G, Ginat DT. Normal Anatomic Structures, Variants, and Mimics of the Temporal Bone. Neuroimaging Clin N Am 2022; 32:345-361. [DOI: 10.1016/j.nic.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
Mughal Z, Charlton AR, Clark M. The Prevalence of Incidental Mastoid Opacification and the Need for Intervention: A Meta-Analysis. Laryngoscope 2021; 132:422-432. [PMID: 33881186 DOI: 10.1002/lary.29581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 11/07/2022]
Abstract
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. LEVEL OF EVIDENCE NA. Laryngoscope, 2021.
Collapse
Affiliation(s)
- Zahir Mughal
- Department of ENT, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Alexander Rowan Charlton
- Department of ENT, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Clark
- Department of ENT, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| |
Collapse
|
6
|
Choi JW, Lee J, Lee DH, Shin JE, Kim CH. Mastoid effusion on temporal bone MRI in patients with Bell's palsy and Ramsay Hunt syndrome. Sci Rep 2021; 11:3127. [PMID: 33542465 PMCID: PMC7862290 DOI: 10.1038/s41598-021-82984-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/27/2021] [Indexed: 12/02/2022] Open
Abstract
This study aimed to investigate the incidence of mastoid effusion on temporal bone magnetic resonance imaging (MRI) in patients with Bell’s palsy (BP) and Ramsay Hunt syndrome (RHS), and evaluate the usefulness of mastoid effusion in early differential diagnosis between BP and RHS. The incidence of mastoid effusion on 3.0 T—temporal bone MRI, which was conducted within 10 days after the onset of acute facial nerve palsy, was compared between 131 patients with BP and 33 patients with RHS. Findings of mastoid cavity on temporal bone MRI were classified into three groups as normal mastoid, mastoid effusion, and sclerotic change, and the incidence of ipsilesional mastoid effusion was significantly higher in RHS than BP (P < 0.001). Tympanic membrane was normal in 7 of 14 RHS patients with mastoid effusion, and injected without middle ear effusion in 7 patients. This study highlights significantly higher incidence of ipsilesional mastoid effusion in RHS than BP, and suggests that the presence of mastoid effusion may provide additional information for differential diagnosis between RHS and BP.
Collapse
Affiliation(s)
- Jin Woo Choi
- Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jiyeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Dong-Han Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Jung Eun Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea.
| |
Collapse
|
7
|
Jung H, Jang KM, Ko MJ, Choi HH, Nam TK, Kwon JT, Park YS. Relationship between Increased Intracranial Pressure and Mastoid Effusion. J Korean Neurosurg Soc 2020; 63:640-648. [PMID: 32883058 PMCID: PMC7477151 DOI: 10.3340/jkns.2020.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/22/2020] [Indexed: 12/02/2022] Open
Abstract
Objective This study aimed to assess the relationship between increased intracranial pressure (ICP) and mastoid effusions (ME).
Methods Between January 2015 and October 2018, patients who underwent intracranial surgery and had ICP monitoring catheters placed were enrolled. ICP was recorded hourly for at least 3 days. ME was determined by the emergence of opacification in mastoid air cells on follow-up brain imaging. C-reactive protein (CRP) levels, presence of endotracheal tube (ETT) and nasogastric tube (NGT), duration of intensive care unit (ICU) stay, duration of mechanical ventilator application, diagnosis, surgical modalities, and presence of sinusitis were recorded. Each factor’s effect on the occurrence of ME was analyzed by binary logistic regression analyses. To analyze the independent effects of ICP as a predictor of ME a multivariable logistic regression analysis was performed.
Results Total of 61 (53%) out of 115 patients had ME. Among the patients who had unilateral brain lesions, 94% of subject (43/50) revealed the ipsilateral development of ME. ME developed at a mean of 11.1±6.2 days. The variables including mean ICP, peak ICP, age, trauma, CRP, ICU stays, application of mechanical ventilators and presence of ETT and NGT showed statistically significant difference between ME groups and non-ME groups in univariate analysis. Sex and the occurrence of sinusitis did not differ between two groups. Adding the ICP variables significantly improved the prediction of ME in multivariable logistic regression analysis.
Conclusion While multiple factors affect ME, this study demonstrates that ICP and ME are probably related. Further studies are needed to determine the mechanistic relationship between ICP and middle ear pressure.
Collapse
Affiliation(s)
- Hoonkyo Jung
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Kyoung Min Jang
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Myeong Jin Ko
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Hyun Ho Choi
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Taek Kyun Nam
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Jeong-Taik Kwon
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Yong-Sook Park
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| |
Collapse
|