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Faizal B, Nair L, Pavithran J, Moni M, Sheejamol VS. Role of surgery along with antimicrobials in refractory skull base osteomyelitis-A prospective observational study. Clin Otolaryngol 2024; 49:640-651. [PMID: 38829037 DOI: 10.1111/coa.14188] [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: 12/26/2022] [Revised: 01/21/2024] [Accepted: 05/18/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Study aimed to ole of surgery along with antimicrobials to improve clinical outcomes in treating refractory cases of skull base osteomyelitis (SBO). METHODS A prospective observational study in a tertiary care centre with 70 SBO patients meeting eligibility criteria. The study population comprised 35 patients refractory to systemic antimicrobials of at least 4 weeks duration who later underwent surgery in addition to medication (surgical group). They were compared with a medical group that responded to medications alone. The outcome variables studied were the resolution of clinical features (pain, discharge, radiology, and inflammatory markers), culture yield, and total duration of treatment. RESULTS According to our study, relief of pain was faster in the surgical group (1.66 against 4.57 months) with statistical significance (p < 0.001). Relief of symptoms (p < 0.001), radiological improvement (p = 0.001), and normalising of inflammatory markers (p < 0.001) were better in the surgical group than in the medical group. The duration of treatment was an average of 9.2 months in the surgical group compared to 11.3 months in the medical group (p = 0.019). Microbial culture from deep tissue sampling was positive in 24 surgical patients (68.57%). CONCLUSIONS The treatment response in selected patients of refractory SBO who underwent surgery along with antimicrobials was better than the group who responded to antimicrobials alone. Surgery provided higher microbial yield resulting in culture-specific antimicrobials. The surgical group observed faster relief of symptoms, reduced hospital stay, and total treatment duration.
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Affiliation(s)
- Bini Faizal
- Department of ENT, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
| | - Lakshmi Nair
- Department of ENT, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
| | - Jayanthy Pavithran
- Department of ENT, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
| | - Merlin Moni
- Division of Infectious Diseases, Department of General Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
| | - V S Sheejamol
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
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Hamiter M, Amorosa V, Belden K, Gidley PW, Mohan S, Perry B, Kim AH. Skull Base Osteomyelitis: Historical Perspective, Diagnosis and Management Update. Otolaryngol Clin North Am 2023; 56:987-1001. [PMID: 37479637 DOI: 10.1016/j.otc.2023.06.004] [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] [Indexed: 07/23/2023]
Abstract
SBO is a life-threatening disease that requires a high index of suspicion based on these patients complex underlying medical co-morbidities and clinician's acumen. Once a diagnosis is made, is it critical to communicate and work closely with other multidisciplinary teams (neuroradiology for appropriate choice of imaging study and interpretation; infectious disease for appropriate medical treatment and duration; internist to properly manage their underlying medical co-morbidities). Despite advances in imaging, the diagnosis is first made based on clinical judgment, appropriate culture, and tissue biopsy.
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Affiliation(s)
- Mickie Hamiter
- Department of Otolaryngology, Columbia University Irving Medical Center, New York, NY, USA
| | - Valerianna Amorosa
- Module E, First floor, Corporal Michael J. Crescenz VA Medical Center, University and Woodlawn Avenue, Philadelphia, PA 19104, USA
| | - Katherine Belden
- Division of Infectious Diseases, Thomas Jefferson University Hospital, 1101 Market Street, Suite 2720, Philadelphia, PA 19107, USA
| | - Paul W Gidley
- Department of Head and Neck Surgery, UT MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA
| | - Suyash Mohan
- Department of Radiology, 219 Dulles Building, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19004, USA
| | - Brian Perry
- Department of OTO-HNS, UT Health San Antonio, Joe R. and Teresa Lozano Long School of Medicine, 7703 Floyd Curl Drive, MC 7777, San Antonio, TX 78229-3900, USA
| | - Ana H Kim
- Department of Otolaryngology, Columbia University Irving Medical Center, New York, NY, USA.
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3
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Ausekar S, Prasad KC, Babu P, Joseph L, G I. Clinical Spectrum and Treatment Response of Malignant Otitis Externa Patients: A Rural Tertiary Care Centre Experience. Cureus 2023; 15:e39518. [PMID: 37366442 PMCID: PMC10290759 DOI: 10.7759/cureus.39518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Malignant otitis externa (MOE) is an invasive external ear infection that has a tendency to spread through the temporal bone and can further progress to involve intracranial structures. Though the prevalence of MOE is rare, high morbidity and mortality are often associated. Complications of advanced MOE include cranial nerve involvement, most commonly facial nerve, and intracranial infections such as abscesses and meningitis. MATERIALS AND METHODS In this retrospective case series of nine patients diagnosed with MOE, demographic data, clinical presentations, laboratory data, and radiological findings were reviewed. All patients were followed up for a minimum period of three months after discharge. Outcomes were measured in terms of reduction in obnoxious ear pain (Visual Analogue Scale), ear discharge, tinnitus, need for re-hospitalization, recurrence of disease, and overall survival. RESULTS In our case series of nine patients (seven males and two females), six underwent surgery, and three patients were managed with a medical line of treatment. All patients had a significant reduction in otorrhea, otalgia, random venous blood sugars, and improvement of facial palsy implicating good response to treatment. CONCLUSION Prompt diagnosis of MOE warrants clinical expertise and aids in preventing complications. A prolonged course of intravenous anti-microbial agents is the mainstay of treatment, but timely surgical interventions in treatment-resistant cases can prevent complications.
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Affiliation(s)
- Shahrukh Ausekar
- Otolaryngology - Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - K C Prasad
- Otolaryngology - Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Prashanth Babu
- Otolaryngology - Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Lini Joseph
- Otolaryngology - Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Induvarsha G
- Otolaryngology- Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
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Tsilivigkos C, Avramidis K, Ferekidis E, Doupis J. Malignant External Otitis: What the Diabetes Specialist Should Know-A Narrative Review. Diabetes Ther 2023; 14:629-638. [PMID: 36897495 PMCID: PMC10064349 DOI: 10.1007/s13300-023-01390-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
AIMS Malignant external otitis (MEO) is a special type of external otitis associated with extensive inflammation and osteomyelitis. It is believed to originate from the external auditory meatus and advance regionally to the soft tissues and the bone, eventually involving the skull base. Pseudomonas aeruginosa and diabetes mellitus are factors commonly involved in the pathogenesis of MEO. Although its treatment has changed considerably during the last decades, morbidity and mortality of the disease remain high. Our aim was to review basic aspects of MEO, a disease unknown until 1968, which attracts great interest among Ears, Nose and Throat (ENT), diabetes and infectious diseases specialists. METHODS AND RESULTS In this narrative review we mainly include relevant papers written in English or with an English abstract. We searched PubMed and Google Scholar, using the keywords malignant external otitis, malignant otitis externa, necrotizing external otitis, skull base osteomyelitis, diabetes mellitus and surgery up to July 2022. Some of the most recent articles, with specific references to earlier articles and a book reference regarding the pathophysiology, diagnosis and treatment of MEO and its relationship to diabetes mellitus, were included. CONCLUSION MEO is not an uncommon disease and is principally treated by ENT surgeons. Nevertheless, diabetes specialists should be aware of the disease presentation and management, since they will often encounter patients with undiagnosed MEO or will need to manage glucose levels in patients hospitalized with the disease.
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Affiliation(s)
- Christos Tsilivigkos
- First Department of Otolaryngology, Hippokration General Hospital, National and Kapodistrian University of Athens, 15772, Athens, Greece.
| | - Konstantinos Avramidis
- Second Department of Internal Medicine, Hippokration General Hospital, 15772, Athens, Greece
| | - Eleftherios Ferekidis
- First Department of Otolaryngology, Hippokration General Hospital, National and Kapodistrian University of Athens, 15772, Athens, Greece
| | - John Doupis
- Department of Internal Medicine and Diabetes, Salamis Naval and Veterans Hospital, Salamis Naval Base, 18900, Salamis Island, Greece
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5
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Takata J, Hopkins M, Alexander V, Bannister O, Dalton L, Harrison L, Groves E, Kanona H, Jones GL, Mohammed H, Andersson MI, Hodgson SH. Systematic review of the diagnosis and management of necrotising otitis externa: Highlighting the need for high-quality research. Clin Otolaryngol 2023; 48:381-394. [PMID: 36759416 DOI: 10.1111/coa.14041] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/30/2022] [Accepted: 01/28/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES To present a systematic review and critical analysis of clinical studies for necrotising otitis externa (NOE), with the aim of informing best practice for diagnosis and management. DESIGN Medline, Embase, Cochrane Library and Web of Science were searched from database inception until 30 April 2021 for all clinical articles on NOE. The review was registered on PROSPERO (ID: CRD42020128957) and conducted in accordance with PRISMA guidelines. RESULTS Seventy articles, including 2274 patients were included in the final synthesis. Seventy-three percent were retrospective case series; the remainder were of low methodological quality. Case definitions varied widely. Median patient age was 69.2 years; 68% were male, 84% had diabetes and 10% had no reported immunosuppressive risk factor. Otalgia was almost universal (96%), with granulation (69%) and oedema (76%) the commonest signs reported. Pseudomonas aeruginosa was isolated in 62%, but a range of bacterial and fungal pathogens were reported and 14% grew no organism. Optimal imaging modality for diagnosis or follow-up was unclear. Median antimicrobial therapy duration was 7.2 weeks, with no definitive evidence for optimal regimens. Twenty-one percent had surgery with widely variable timing, indication, or procedure. One-year disease-specific mortality was 2%; treatment failure and relapse rates were 22% and 7%, respectively. CONCLUSION There is a lack of robust, high-quality data to support best practice for diagnosis and management for this neglected condition. A minimum set of reporting requirements is proposed for future studies. A consensus case definition is urgently needed to facilitate high-quality research.
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Affiliation(s)
- Junko Takata
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.,Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Michael Hopkins
- Department of Ear, Nose and Throat Surgery, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Victoria Alexander
- Department of Ear, Nose and Throat Surgery, St George's University Hospital NHS Trust, London, UK
| | - Oliver Bannister
- Department of Infection, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Modernising Medical Microbiology, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lucy Dalton
- Department of Ear, Nose and Throat Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Laura Harrison
- Department of Ear, Nose and Throat Surgery, Royal Berkshire Hospital, Reading, UK
| | - Emily Groves
- Department of General Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Hala Kanona
- Department of Ear, Nose and Throat Surgery, The Royal National Ear Nose and Throat and Eastman Dental Hospital, University College London Hospitals NHS Trust, London, UK
| | | | - Hassan Mohammed
- Department of Ear, Nose and Throat, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Monique I Andersson
- Department of Infection, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Susanne H Hodgson
- Department of Infection, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Biochemistry, University of Oxford, Oxford, UK
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Freeman MH, Perkins EL, Tawfik KO, O'Malley MR, Labadie RF, Haynes DS, Bennett ML. Facial Paralysis in Skull Base Osteomyelitis - Comparison of Surgical and Nonsurgical Management. Laryngoscope 2023; 133:179-183. [PMID: 35546515 DOI: 10.1002/lary.30161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 02/02/2023]
Abstract
TITLE Facial Paralysis in Skull Base Osteomyelitis - Comparison of Surgical and Nonsurgical Management. OBJECTIVE To compare outcomes of surgical and nonsurgical management in cases of facial paresis secondary to skull base osteomyelitis. METHODS A 14 patients presenting with skull base osteomyelitis complicated by facial nerve paresis at a single tertiary referral center from 2009 to 2019 were retrospectively reviewed. Patients were treated with medical therapy with or without surgical intervention, consisting of mastoidectomy and debridement with or without facial nerve decompression. House-Brackmann (HB) Grade was the main outcome measure. RESULTS A 14 patients (average age 68 years, range 58-82 years, 71% male) were analyzed, with 5 undergoing facial nerve decompression (36%), 5 undergoing mastoidectomy without facial nerve decompression (36%), and 4 undergoing medical management alone (28%). Of the 4 patients who underwent medical therapy alone, none experienced significant improvement in facial function. Of the 5 patients who underwent facial nerve decompression, 3 patients experienced improved facial function. Of the 5 patients who underwent mastoidectomy without decompression, 4 experienced improved facial function. There was no clear link between the severity of infection and the severity of facial paresis. When comparing HB score changes before and after treatment across groups, there was no statistically significant difference seen (p = 0.47). CONCLUSIONS Mastoidectomy and debridement with or without facial nerve decompression may improve facial nerve outcomes when compared to isolated medical management, although differences were not of statistical significance. The best facial nerve recoveries occurred in patients undergoing surgery within 14 days of the onset of paralysis. LEVEL OF EVIDENCE 4 - Case Series Laryngoscope, 133:179-183, 2023.
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Affiliation(s)
- Michael H Freeman
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth L Perkins
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kareem O Tawfik
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew R O'Malley
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert F Labadie
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David S Haynes
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Arslan IB, Pekcevik Y, Cukurova I. Management and long-term comorbidities of patients with necrotizing otitis externa. Eur Arch Otorhinolaryngol 2022; 280:2755-2761. [PMID: 36528642 PMCID: PMC9759449 DOI: 10.1007/s00405-022-07784-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE We aimed to present the management of the patients with necrotizing otitis externa (NOE) and its comorbidities in early and long-term follow-up. METHODS Between 2011 and 2022, 30 patients with the diagnose of NEO, who had cortical bone erosion or trabecular demineralization in temporal bone computed tomography and administered at least 6-week antimicrobial therapy were included in the study. Clinical, laboratory and imaging findings of patients, and comorbidities during follow-up were analysed. NOE extending further from the petro-occipital fissure on magnetic resonance imaging was accepted as medial skull base (MSB) involvement. RESULTS 30 patients, (8 women, 22 men, mean age 66.2 ± 1.7), with NOE were followed 36.4 ± 29.6 months. The mortality rate was 23.33% and the mean survival time was 12.37 ± 11.35 months. Repeated cultures reveal a new or second pathogen in 5 patients (20%). Severe and profound sensorineural hearing loss (SNHL) were observed in 4 and 12 patients, respectively. Labyrinthitis ossificans emerged in 3 of 6 surviving patients with profound SNHL during follow-up. Chronic disease anemia (CDA) (66.66%), cerebrovascular disease (CVD) (43.33%), chronic renal failure (CRF) (30%), and retinopathy (26.66%) were the most frequent comorbidities in patients with NOE. Cranial nerve paralysis (CNP) (P < 0.001), SNHL (P < 0.04), CDA (P < 0.005), and mortality (P < 0.022) were significantly associated with the presence of MSB involvement. CONCLUSIONS NOE is a disease that requires long-term follow-up, causes severe morbidity, and has a high mortality rate. MSB involvement is associated with CNP, SNHL and labyrinthitis ossificans. Moreover, CDA, CVD, CRF and retinopathy are the most common comorbitidies needed to be managed.
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Affiliation(s)
- Ilker Burak Arslan
- Department of Head Neck Surgery, Tepecik Training and Research Hospital, Health Science University, Izmir Tepecik SUAM Gaziler Bulvarı No:468, Yenisehir, Konak Izmir, Turkey
| | - Yeliz Pekcevik
- Department of Radiology, Tepecik Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Ibrahim Cukurova
- Department of Head Neck Surgery, Tepecik Training and Research Hospital, Health Science University, Izmir Tepecik SUAM Gaziler Bulvarı No:468, Yenisehir, Konak Izmir, Turkey
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Amraoui O, Belhaj N, Nitassi S, Oujilal A, Essakalli L. Necrotizing Otitis Concealing Carcinomas of the External Auditory Canal. Indian J Otolaryngol Head Neck Surg 2022; 74:4306-4313. [PMID: 36742872 PMCID: PMC9895423 DOI: 10.1007/s12070-021-02972-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/31/2021] [Indexed: 02/07/2023] Open
Abstract
External auditory canal Carcinomas are rare and aggressive tumors and their prognosis depends on early diagnosis. Their clinical similarity to necrotizing otitis is a source of error and therefore of diagnostic delay. Hence the interest of our study which consists in providing ENT specialists and all practitioners with the necessary clinical, evolutionary, radiological, biological and histological elements to avoid diagnostic errors. This is a retrospective study of all patients who were hospitalized for necrotizing otitis in the department of otolaryngology of the hospital of specialties of Rabat spread over a period of 5 years. All patients received an admission CT scan, biological tests, bacteriological sampling and biopsy. As well as initial parenteral antibiotic therapy and surgery for incidentally discovered EAC carcinomas. Clinically, all patients had otalgia and granulation tissue on otoscopic examination under the microscope. 50% had otorrhea. Pseudomonas aeruginosa was isolated in 50% of the cases, staphylococcus aureus in 25% and sterile culture in 25%. From the first biopsy, the diagnosis of tumor was retained in 6/10 patients. A second biopsy was performed in patients who did not show improvement and had a sterile culture. This one allowed the diagnosis in 4 other patients. All our patients had a surgical indication and were operated and then irradiated. The survival at 5 years was 50%. Biopsy must be systematic for every patient hospitalize for necrotizing otitis. Without hesitating to do it again each time the evolution is not good and the culture is sterile.
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Affiliation(s)
- Oussama Amraoui
- Department of Otolaryngology, Head and Neck Surgery, Ibn Sina University Hospital, University Mohamed 5, Sect 9, Bloc B N° 16, Hay Riad, Rabat, Morocco
| | - Najwa Belhaj
- Department of Otolaryngology, Head and Neck Surgery, Ibn Sina University Hospital, University Mohamed 5, Sect 9, Bloc B N° 16, Hay Riad, Rabat, Morocco
| | - Sophia Nitassi
- Department of Otolaryngology, Head and Neck Surgery, Ibn Sina University Hospital, University Mohamed 5, Sect 9, Bloc B N° 16, Hay Riad, Rabat, Morocco
| | - Abdelilah Oujilal
- Department of Otolaryngology, Head and Neck Surgery, Ibn Sina University Hospital, University Mohamed 5, Sect 9, Bloc B N° 16, Hay Riad, Rabat, Morocco
| | - Leila Essakalli
- Department of Otolaryngology, Head and Neck Surgery, Ibn Sina University Hospital, University Mohamed 5, Sect 9, Bloc B N° 16, Hay Riad, Rabat, Morocco
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Macias D, Jeong SS, Van Swol JM, Moore JD, Brennan EA, Raymond M, Nguyen SA, Rizk HG. Trends and Outcomes of Fungal Temporal Bone Osteomyelitis: A Scoping Review. Otol Neurotol 2022; 43:1095-1107. [PMID: 36351221 DOI: 10.1097/mao.0000000000003714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Temporal bone osteomyelitis is an invasive infection most often caused by bacteria and associated with high mortality. Fungal etiologies are rare and little is known of the predictors of disease severity and outcomes in fungal temporal bone osteomyelitis. MATERIALS AND METHODS A scoping review was performed to determine what is known from the literature on how clinical, diagnostic, and treatment characteristics relate to patient outcomes in fungal temporal bone osteomyelitis. Using PRISMA guidelines, three databases were searched to identify all published cases of fungal temporal bone osteomyelitis. Data were extracted from each study, including clinical, diagnostic, and treatment characteristics, and outcomes. RESULTS Sixty-eight studies comprising 74 individual cases of fungal temporal bone osteomyelitis were included. All studies were case reports. There were high rates of diabetes, facial nerve palsy, infectious complications, and need for surgical intervention, as well as a significant delay in the evaluation and diagnosis of fungal temporal bone osteomyelitis. Disease recovery was greater in patients presenting with otorrhea, comorbid diabetes, and in those without facial nerve palsy. DISCUSSION Many of the defining characteristics of fungal temporal bone osteomyelitis remain unknown, and future reports should focus on determining factors that improve timely diagnosis and treatment of fungal TBO in addition to identifying prognostic indicators for outcomes and survival.
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Affiliation(s)
- David Macias
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina
| | - Seth S Jeong
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina
| | | | - Jeremy D Moore
- College of Medicine, Medical University of South Carolina
| | - Emily A Brennan
- MUSC Libraries, Medical University of South Carolina, Charleston, South Carolina
| | - Mallory Raymond
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina
| | - Shaun A Nguyen
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina
| | - Habib G Rizk
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina
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Danjou W, Chabert P, Perpoint T, Pradat P, Miailhes P, Boibieux A, Becker A, Fuchsmann C, Laurent F, Tringali S, Roux S, Triffault-Fillit C, Valour F, Ferry T. Necrotizing external otitis: analysis of relapse risk factors in 66 patients managed during a 12 year period. J Antimicrob Chemother 2022; 77:2532-2535. [PMID: 35696322 DOI: 10.1093/jac/dkac193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/16/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Necrotizing external otitis (NEO) is a severe infection of the skull base that occurs generally in the elderly and/or in diabetic recipients. There are few data in the literature about the therapeutic management of this complex bone infection. OBJECTIVES To analyse relapses after NEO treatment completion, and to describe the clinical features of NEO. METHODS We performed a retrospective cohort study in the Lyon regional reference centre for the management of complex bone and joint infections. Consecutive cases of NEO from 1 January 2006 to 31 December 2018 were included. The primary outcome was the relapse of NEO. Variables were analysed using Cox regression survival analysis with adjusted hazard ratio (aHR) and Kaplan-Meier curve. RESULTS Sixty-six patients were included. Median age was 75 (IQR 69-81) years and 46 (70%) patients were diabetic. Eleven patients (17%) had temporomandibular arthritis, 10 (15%) cranial nerve paralysis, 2 (3%) cerebral thrombophlebitis, and 2 (3%) contiguous abscess. Microbiological documentation was obtained in 56 patients and revealed Pseudomonas aeruginosa in 44/56 patients (79%). Nine (14%) cases had no microbiological documentation. Antibiotic therapy was dual for 63 (95%) patients. During a median follow-up of 27 (IQR 12-40) months, 16 out of 63 (25%) patients experienced a relapse. Fungal infection was significantly associated with relapse [aHR 4.1 (95% CI 1.1-15); P = 0.03]. CONCLUSIONS NEO is a severe bone infection, mainly (but not exclusively) caused by P. aeruginosa, which occurs in elderly and diabetic recipients. Fungal infections at baseline significantly impact the outcome.
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Affiliation(s)
- William Danjou
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - Paul Chabert
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - Thomas Perpoint
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - Pierre Pradat
- Hospices Civils de Lyon, Centre de recherche clinique, Groupement Hospitalier Nord, Lyon, France
| | - Patrick Miailhes
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - André Boibieux
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - Agathe Becker
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - Carine Fuchsmann
- Hospices Civils de Lyon, Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Hôpital de la Croix Rousse, Lyon, France
| | - Frédéric Laurent
- Hospices Civils de Lyon, Laboratoires de bactériologie, Institut des Agents Infectieux, Hôpital de la Croix Rousse, Lyon, France
| | - Stephane Tringali
- Hospices Civils de Lyon, Chirurgie maxillo-faciale, stomatologie, chirurgie orale et chirurgie plastique de la face, Centre Hospitalier Lyon Sud, Pierre Bénite, France.,Université Claude-Bernard-Lyon 1, Lyon, France
| | - Sandrine Roux
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - Claire Triffault-Fillit
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - Florent Valour
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France.,Université Claude-Bernard-Lyon 1, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Tristan Ferry
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France.,Université Claude-Bernard-Lyon 1, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
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11
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Bigdeli R, Jabbour J, Noor A, Bradshaw K, North H, Singh N, Sritharan N. Cotton bud foreign body associated necrotising otitis externa – a case series and literature review. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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12
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Ijaz A, Williams E, Cole J, Watson G. Necrotising Otitis Externa Antibiotic therapy complications: A retrospective cohort analysis. Clin Otolaryngol 2022; 47:491-494. [PMID: 35194951 DOI: 10.1111/coa.13921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
NOE is a rare but life-threatening condition. Treatment is long-term intravenous antibiotics. However, there is no evidence on the complications of antibiotic treatment in this complex cohort of patients In our study, patients on average are treated with two different antibiotic regimes 63% of these changes in regimen are due to direct adverse effects from treatment including drug intolerance and lack of significant clinical response leading to deterioration and morbid complications Patients requiring multiple antibiotic regimes have a statistically longer duration of treatment. These adverse effects appear to occur more frequently in patients with additional comorbidities. This novel data provides information clinicians can use when initiating treatment for NOE and counsel patients appropriately.
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Affiliation(s)
- Ali Ijaz
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF
| | - Emma Williams
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF
| | - Joby Cole
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF
| | - Glen Watson
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF
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13
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Koshiba Y, Ikeda R, Suzuki J, Honkura Y, Funayama Y, Ikeda K, Warita H, Aoki M, Kawase T, Katori Y. Malignant otitis externa presenting cerebral infarction from pseudoaneurysm: A case report and a review of the literature. Clin Case Rep 2022; 10:e05276. [PMID: 35223001 PMCID: PMC8843815 DOI: 10.1002/ccr3.5276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/24/2021] [Accepted: 12/29/2021] [Indexed: 11/24/2022] Open
Abstract
Chronic renal failure and diabetes mellitus could also be risk factors of pseudoaneurysm of the internal carotid artery (ICA) due to malignant otitis externa (MOE). Although pseudoaneurysm of the ICA is a rarely encountered disease, it should always be taken into consideration when treating patients of MOE.
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Affiliation(s)
- Yasutoshi Koshiba
- Department of Otolaryngology, Head and Neck SurgeryTohoku University School of MedicineSendaiJapan
| | - Ryoukichi Ikeda
- Department of Otolaryngology, Head and Neck SurgeryTohoku University School of MedicineSendaiJapan
| | - Jun Suzuki
- Department of Otolaryngology, Head and Neck SurgeryTohoku University School of MedicineSendaiJapan
| | - Yohei Honkura
- Department of Otolaryngology, Head and Neck SurgeryTohoku University School of MedicineSendaiJapan
| | - Yukino Funayama
- Department of NeurologyTohoku University School of MedicineSendaiJapan
| | - Kensuke Ikeda
- Department of NeurologyTohoku University School of MedicineSendaiJapan
| | - Hitoshi Warita
- Department of NeurologyTohoku University School of MedicineSendaiJapan
| | - Masashi Aoki
- Department of NeurologyTohoku University School of MedicineSendaiJapan
| | - Tetsuaki Kawase
- Department of Otolaryngology, Head and Neck SurgeryTohoku University School of MedicineSendaiJapan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck SurgeryTohoku University School of MedicineSendaiJapan
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14
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Emerging themes in necrotising otitis externa: a scoping review of the literature 2011-2020 and recommendations for future research. The Journal of Laryngology & Otology 2021; 136:575-581. [PMID: 34666847 DOI: 10.1017/s0022215121003030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Abstract
PURPOSE OF REVIEW Skull base osteomyelitis (SBO) is a life-threatening condition. Due to an aging and increasingly multimorbid population, clinicians are more often challenged with this disease. Yet, there is no consensus on the optimal diagnostic and follow-up management. This review should aid clinicians in decision-making for their patients. RECENT FINDINGS Treatment-resistant otalgia or headache is suspicious of SBO. Pseudomonas aeruginosa remains the most common pathogen but clinicians are challenged with increasing rates of sterile or fungal cultures due to previously applied antibiotics/steroids. No single imaging modality is able to detect the full extent of the disease. Whereas functional nuclear imaging with gallium-67 or methylene diphosphonate-technetium-99m was once advocated, its actual benefit is questionable. Newer modalities such as fluoro-D-glucose-positron emission tomography (PET)/computed tomography, PET/magnetic resonance imaging (MRI), or diffusion-weighted MRI seem to be promising in diagnosis and follow-up. Finding the causative pathogen is of utmost importance followed by long-term intravenous antibiotics until the disease has completely resolved. Surgery plays a minor role in treatment but can be helpful in selected cases. SUMMARY The numerous challenges in SBO render management difficult, but with a clear work-up including regular clinical, laboratory and imaging examinations, outcome can be improved.
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Affiliation(s)
- Alice B Auinger
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
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16
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Treviño González JL, Reyes Suárez LL, Hernández de León JE. Malignant otitis externa: An updated review. Am J Otolaryngol 2021; 42:102894. [PMID: 33429178 DOI: 10.1016/j.amjoto.2020.102894] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/27/2020] [Indexed: 11/18/2022]
Abstract
Malignant otitis externa is a progressive infection of the external auditory canal and skull base. Pseudomonas aeruginosa is the most isolated microorganism and it affects mostly to diabetic, elderly, and immunocompromised individuals. Non-resolving otalgia and chronic otorrhea are the clinical manifestations presented. Facial nerve palsy is a common and well recognized complication. (Computed tomography) CT scan is useful for initial assessment, Technetium-99m is highly sensitive and is part of the protocol for diagnosis. Treatment should be individualized, with multidisciplinary cooperation among specialties. Management involves systemic antipseudomonal antibiotics and monitoring with radiologic techniques, it also involves the strict control of diabetes. It is essential to follow up the patients for at least a year post-treatment. In refractory malignant otitis externa and affection of facial nerve, surgical management is recommended. We reviewed the most recent studies on epidemiology, clinical manifestations, diagnosis, and treatment to provide an update on Malignant Otitis Externa that can offer an overview for clinical practice and future research.
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17
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Dabiri S, Karrabi N, Yazdani N, Rahimian A, Kheiltash A, Hasibi M, Saedi E. Facial nerve paralysis in malignant otitis externa: comparison of the clinical and paraclinical findings. Acta Otolaryngol 2020; 140:1056-1060. [PMID: 32852248 DOI: 10.1080/00016489.2020.1808242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Malignant otitis externa is an uncommon but critical challenging disease with some degree of cranial nerve involvement. AIM/OBJECTIVE to examine the factors leading to facial paralysis in these patients and clarify indications for aggressive treatment in the group most at risk. MATERIAL AND METHODS In a case-control study, demographic, clinical, laboratory, audiometric, imaging, and treatment characteristics of 139 patients in groups with and without facial paralysis were analysed. RESULTS 45 patients (32.4%) had facial paralysis. Compared to patients without facial nerve involvement, patients with facial palsy had a higher rate of inflammatory markers (mean erythrocyte sedimentation rate on admission [67.71 vs 51.16 mm/h], and the average of total ESR [64.27 vs 54.46 mm/h], as well as the mean C-reactive protein [38.96 vs 27.53 mg/L]). Also, the involvement of the facial canal (p < .01) and nasopharyngeal space (p < .05) were related to the incidence of facial paralysis. CONCLUSION Nasopharyngeal extension of the inflammation and facial nerve canal erosion might be useful as predictors of facial nerve dysfunction. The elevated erythrocyte sedimentation rate is correlated with the increased risk of facial paralysis, and aggressive medical management is more crucial. SIGNIFICANCE Improvement in predicting the outcome of patients with malignant otitis externa.
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Affiliation(s)
- Sasan Dabiri
- Otorhinolaryngology Research Center, Department of Otolaryngology-Head and Neck Surgery, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Karrabi
- Otorhinolaryngology Research Center, Department of Otolaryngology-Head and Neck Surgery, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Yazdani
- Otorhinolaryngology Research Center, Department of Otolaryngology-Head and Neck Surgery, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Rahimian
- Otorhinolaryngology Research Center, Department of Otolaryngology-Head and Neck Surgery, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azita Kheiltash
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Hasibi
- Department of Internal Medicine (Infectious Diseases division), Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Saedi
- Department of Internal Medicine (Neurology division), Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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18
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Prakairungthong S, Atipas S, Rongrungruang Y, Ngamskulrungroj P, Chongkolwatana C. Fusarium malignant otitis externa in an immunocompetent host. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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19
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Kuczkowski J, Nowicki TK. Indications for surgery in necrotizing otitis externa. Eur Arch Otorhinolaryngol 2020; 279:3219-3220. [PMID: 32488376 DOI: 10.1007/s00405-020-06092-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Jerzy Kuczkowski
- Department of Otolaryngology, Medical University of Gdańsk, Smoluchowskiego 17, 80-214, Gdansk, Poland.
| | - Tomasz K Nowicki
- Department of Radiology, Medical University of Gdańsk, Smoluchowskiego 17, 80-214, Gdansk, Poland
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