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Gomes PM, Cabral DC, Costa JB, Fernandes T, Camacho Ó, Penêda JF, Duarte D, Viana M. Hyperbaric oxygen therapy in malignant otitis externa: a retrospective analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08734-6. [PMID: 38767696 DOI: 10.1007/s00405-024-08734-6] [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: 01/28/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Malignant otitis externa (MOE) is a rare form of invasive osteomyelitis of the external ear canal. It is typically caused by Pseudomonas aeruginosa in immunocompromised patients. The diagnosis is clinical, and the initial treatment involves systemic antibiotics or antifungal therapy. Surgery is usually only considered when medical treatment has failed. Although hyperbaric oxygen therapy (HBOT) is recommended for refractory osteomyelitis, there are no specific guidelines for MOE. METHODS This is a retrospective study that evaluates clinical data, treatment, and results obtained in patients diagnosed with MOE treated with HBOT at the Pedro Hispano Hospital between 2007 and 2022. RESULTS During the study period, fifteen patients diagnosed with MOE were admitted for treatment with HBOT. All patients received antibiotic and/or antifungal therapy, and three required surgical intervention before starting HBOT. The pathology was successfully managed on all patients. CONCLUSIONS HBOT may be an effective adjuvant treatment option in patients with MOE but it lacks robust scientific evidence. However, its therapeutic value should not be underestimated due to the good results and few adverse effects reported in recent retrospective studies and case reports.
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Affiliation(s)
- Pedro Marques Gomes
- Department of Otorhinolaryngology, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Rua de Santo António, Lote 14, São Pedro do Sul, Porto, Portugal.
| | - Diogo Cunha Cabral
- Department of Otorhinolaryngology, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Rua de Santo António, Lote 14, São Pedro do Sul, Porto, Portugal
| | - Joana Borges Costa
- Department of Otorhinolaryngology, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Rua de Santo António, Lote 14, São Pedro do Sul, Porto, Portugal
| | - Tiago Fernandes
- Department of Hyperbaric Medicine, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Porto, Portugal
| | - Óscar Camacho
- Department of Hyperbaric Medicine, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Porto, Portugal
| | - José Ferreira Penêda
- Department of Otorhinolaryngology, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Rua de Santo António, Lote 14, São Pedro do Sul, Porto, Portugal
| | - Delfim Duarte
- Department of Otorhinolaryngology, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Rua de Santo António, Lote 14, São Pedro do Sul, Porto, Portugal
| | - Miguel Viana
- Department of Otorhinolaryngology, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Rua de Santo António, Lote 14, São Pedro do Sul, Porto, Portugal
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Krishnakumar L, Vinayakumar V, Suchit Roy BR, Gopalan M, Venugopal M. Skull Base Osteomyelitis- Marauders of the Skull. Indian J Otolaryngol Head Neck Surg 2024; 76:1770-1774. [PMID: 38566647 PMCID: PMC10982152 DOI: 10.1007/s12070-023-04405-w] [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: 10/31/2023] [Accepted: 11/22/2023] [Indexed: 04/04/2024] Open
Abstract
Skull base osteomyelitis is a vicious infection of temporal bone associated with very high morbidity and mortality. But few studies have been undertaken recently for eliciting its increasing incidence. Hence this study aims to describe the clinical profile of skull base osteomyelitis and changes noted in the post-covid period, and encourage a uniform treatment policy globally. This descriptive study was conducted among 140 patients diagnosed with skull base osteomyelitis. Data was collected using semi-structured proforma, HRCT temporal bone findings, microbiological reports, histopathology of granulation tissue, ESR and House-Brackmann grading. Male patients in 61-70 age group were most commonly affected and all patients had uncontrolled diabetes mellitus, usually presenting with nocturnal otalgia, ear canal granulation and cranial nerve palsy. Pseudomonas aeruginosa was the most common isolate followed by Staphylococcus aureus. Among fungal pathogens, candida albicans were the most common. 29.3% patients had extensive disease according to Thakar et al. staging and on follow up, 43.75% patients showed a satisfactory response. Coronary artery disease and cerebrovascular accidents were the leading cause of death. More atypical organisms, extensive disease and changes in antibiotic sensitivity were noted in the post-covid period. Prolonged treatment with culture sensitive antibiotic is the main stay of treatment. A uniform treatment guideline is needed for proper management of such patients. Level of Evidence 4.
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Affiliation(s)
- Lakshmi Krishnakumar
- Department of ENT, Government Medical College, Thiruvananthapuram, Kerala 695011 India
| | - Vishnu Vinayakumar
- Department of ENT, Government Medical College, Thiruvananthapuram, Kerala 695011 India
| | - B. R. Suchit Roy
- Department of ENT, Government Medical College, Thiruvananthapuram, Kerala 695011 India
| | - Manoj Gopalan
- Department of ENT, Government Medical College, Thiruvananthapuram, Kerala 695011 India
| | - M. Venugopal
- Department of ENT, Government Medical College, Thiruvananthapuram, Kerala 695011 India
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3
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Ahmed AA, Rashid S, Gupta VK, Molony NC, Gupta KK. The diagnostic conundrum in necrotizing otitis externa. World J Otorhinolaryngol Head Neck Surg 2024; 10:59-65. [PMID: 38560038 PMCID: PMC10979047 DOI: 10.1002/wjo2.100] [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: 10/27/2022] [Revised: 02/23/2023] [Accepted: 04/10/2023] [Indexed: 04/04/2024] Open
Abstract
Necrotizing otitis externa (NOE) is an aggressive and fast-evolving infection of the external auditory canal. Late diagnoses and untreated cases can lead to severe, even fatal consequences and so early diagnosis and treatment are paramount. NOE is a notoriously challenging diagnosis to make. It is therefore important to understand what diagnostic modalities are available and how otolaryngologists can use them to accurately treat such an aggressive disease. This review aims to evaluate the different diagnostic options available in NOE and discuss their advantages and limitations, thus, providing an up-to-date picture of the multimodal approach required in the diagnosis of this disease.
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Affiliation(s)
- Abiya A. Ahmed
- Bradford Royal InfirmaryBradford Teaching Hospitals NHS Foundation TrustWest BromwichWest YorkshireUK
| | - Shaan Rashid
- Bradford Royal InfirmaryBradford Teaching Hospitals NHS Foundation TrustWest BromwichWest YorkshireUK
| | - Vinay K. Gupta
- Sandwell and West Birmingham Hospitals NHS TrustWest BromwichUK
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4
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Charan BD, Thanneru S, Sebastian LJD, Jain S. Reconstructive endovascular treatment of petrous ICA pseudoaneurysm in skull base osteomyelitis: a hidden catastrophe. BMJ Case Rep 2024; 17:e258539. [PMID: 38417939 PMCID: PMC10900339 DOI: 10.1136/bcr-2023-258539] [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: 03/01/2024] Open
Abstract
Skull base osteomyelitis can be more life-threatening in immunocompromised patients and patients with diabetes. Here, we present a case of a petrous internal carotid artery pseudoaneurysm resulting from skull base osteomyelitis in a diabetic male in his 50s. This case report highlights the need to be conscious of the various complications associated with skull base osteomyelitis, be proficient in detecting them and treat them as early as possible for better outcomes. After adequate control of the disease process with medical treatment, immediate management of the aneurysm with balloon angioplasty and stenting was done. Acknowledging the trivial nasal and ear bleed, radiological evaluation is necessary to rule out rare complications like pseudoaneurysms in a diagnosed case of skull base osteomyelitis. In the discussion, we have cited the various treatment methods and similar cases of pseudoaneurysm caused by osteomyelitis. Currently, the patient continues to live a disease and disability-free life.
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Aon M, Aoun AH, Al Shami A, Alharbi A, Aljenfawi K, Al-Anazi S, Salman F, Assaf M, Mobarak M, AlRoomi E, Abdelwahab OA, Ibrahim MM. Association of Diabetes Mellitus With Increased Mortality in Carbapenem-Resistant Enterobacterales Infections. Cureus 2024; 16:e53606. [PMID: 38449962 PMCID: PMC10915714 DOI: 10.7759/cureus.53606] [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: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Carbapenem-resistant Enterobacterales (CRE) infections have high mortality. We aimed to examine the diabetes mellitus (DM) association with CRE mortality. Methodology Our study is a retrospective cohort study including patients who were admitted to the medical wards in the main district hospital (New Jahra Hospital, Kuwait) between January 1, 2022, and January 1, 2023, and diagnosed with CRE infections during hospitalization. The patients were divided into diabetic and non-diabetic groups. Clinical and laboratory data were collected. The presence of carbapenemase genes was detected. The primary outcome was 30-day hospital mortality. We assessed the effect of glycemic control on the outcomes. Results We included 47 patients in the diabetic group and 39 patients in the non-diabetic group. Females represented 54.7% of patients, and the median age was 73 and 55 years in the two groups, respectively. Klebsiella pneumonia (86%) and Escherichia coli (12.8%) were the most frequently isolated CRE. Carbapenemase genes were detected in all patients: NDM-1 in 67.4%, OXA-48 in 18.6%, and both genes coexisted in 14%. The 30-day hospital mortality was significantly higher in the diabetic group compared to the non-diabetic group (48.9% vs. 28.2%, P = 0.041). Among the diabetic patients, there was no significant difference between survivors and non-survivors regarding median glucose or glycated hemoglobin (HbA1c) levels (P = 0.465 and 0.932, respectively). Moreover, levels of glucose (odds ratio (OR) 0.928, confidence interval (CI) 0.763-1.13, P = 0.457) and HbA1c (OR 0.89, CI 0.63-1.26, P = 0.507) were not risk factors for increased mortality among diabetic patients. Conclusion We demonstrated the association between DM and increased CRE mortality regardless of the level of glycemic control. This study demonstrates the interaction between communicable and non-communicable diseases.
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Affiliation(s)
- Mohamed Aon
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, EGY
| | - Ahmed H Aoun
- Department of Pediatrics, Faculty of Medicine, Cairo University, Giza, EGY
- Department of Pediatrics, Primary Health Care Corporation, Doha, QAT
| | - Ahmad Al Shami
- Department of Internal Medicine, New Jahra Hospital, Jahra, KWT
| | | | | | - Sarah Al-Anazi
- Department of Internal Medicine, New Jahra Hospital, Jahra, KWT
| | - Fares Salman
- Department of Internal Medicine, New Jahra Hospital, Jahra, KWT
| | - Mohammed Assaf
- Department of Internal Medicine, New Jahra Hospital, Jahra, KWT
| | - Magd Mobarak
- Department of Microbiology, New Jahra Hospital, Jahra, KWT
| | | | - Omar A Abdelwahab
- Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Mohamed M Ibrahim
- Department of Internal Medicine, Jaber Al-Ahmed Armed Forces Hospital, Kuwait, KWT
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6
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Nguyen PT, Chang J, Shahlaie K, Raslan O, Ozturk A, Bobinski M, Assadsangabi R. Skull base infections, their complications, and management. Neuroradiol J 2024; 37:6-16. [PMID: 36382775 PMCID: PMC10863568 DOI: 10.1177/19714009221140540] [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: 01/14/2024] Open
Abstract
OBJECTIVE Our review aims to summarize the current literature on skull base infections (SBIs) and retrospectively analyze any such cases encountered at our institution. DESIGN A literature search was conducted using online databases PubMed, MEDLINE, and ResearchGate with the terms "skull base osteomyelitis," "temporal bone osteomyelitis," "skull base infections," "necrotizing otitis media," and "SBO". References from the resulting manuscripts were reviewed for relevant articles. A search of our electronic health records using the same key terms was also performed to identify patients with a tissue biopsy-confirmed diagnosis of skull base infections. Patients with an indeterminate diagnosis or inaccessible/poor imaging were excluded. SETTING A level one trauma and major tertiary academic medical center. PARTICIPANTS All patients treated at the University of California Davis Health System with a confirmed diagnosis of skull base infections from January 2005 to November 2020. MAIN OUTCOME MEASURES Imaging results, symptoms, treatment, morbidity, and mortality. RESULTS Our literature search yielded 59 articles ranging from 1982 to 2021. A retrospective search of our electronic health records identified two cases of skull base infections. CONCLUSION Skull base infections have no pathognomonic findings. A multimodal approach with computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine is necessary to characterize the disease process in addition to a biopsy for definitive diagnosis. Other diagnoses can mimic SBI on imaging, such as nasopharyngeal carcinoma and inflammatory pseudotumor. Culture-guided antimicrobial treatment and surgery are mainstay therapies. Other adjuvant strategies currently lack the robust evidence necessary to characterize their risks and benefits.
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Affiliation(s)
- Phat Tan Nguyen
- Internal Medicine, Kaiser Permanente San Francisco, San Francisco, CA, USA
| | - Jennifer Chang
- Department of Radiology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Osama Raslan
- Department of Radiology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Arzu Ozturk
- Department of Radiology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Matthew Bobinski
- Internal Medicine, Kaiser Permanente San Francisco, San Francisco, CA, USA
| | - Reza Assadsangabi
- Department of Radiology, Keck School of Medicine of USC University of Southern California, Sacramento, CA, USA
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Wang Q, Hu R, Zhu Y, Zhu W, Jiang H. Case Report: The application of metagenomic next generation sequencing in diagnosing fungal malignant external otitis: a report of two cases. Front Cell Infect Microbiol 2023; 13:1236414. [PMID: 38053531 PMCID: PMC10694228 DOI: 10.3389/fcimb.2023.1236414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
Background Most of malignant external otitis (MEO) cases reported in the literature are attributed to Pseudomonas aeruginosa. Fungal infections in MEO are also likely but extremely rare. And conventional microbiology tests is difficult to diagnose. Case description Two patients were diagnosed with Fungal malignant external otitis (FMEO) due to Aspergillus by metagenomic Next-Generation Sequencing (mNGS) and recovered after comprehensive treatment including operation and voriconazole. The antifungal treatment was delayed due to repeated cultures of secretions being negative and pathological examination showed granulation tissue proliferation with extensive neutrophil infiltration. Conclusion mNGS might be helpful for patients suspected with FMEO, especially when conventional microbiology tests were negative.
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Affiliation(s)
| | | | | | | | - Hua Jiang
- Department of Otolaryngology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
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8
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Fenberg RB, Sylvester MJ, Davidson S, McKean EL, VanKoevering KK. Central Skull Base Osteomyelitis: A Case Series from a Tertiary Care Center Over 5 Years. Ann Otol Rhinol Laryngol 2023; 132:1300-1305. [PMID: 36648119 DOI: 10.1177/00034894221147806] [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: 01/18/2023]
Abstract
OBJECTIVE Skull base osteomyelitis may rarely present in the sphenoid bone or clivus without an otologic source. This is referred to as central skull base osteomyelitis (CSBO). Knowledge regarding CSBO is limited to case reports and small case series. Here we present a case series to further describe typical patient characteristics, clinical presentation, and clinical course associated with this rare infection. METHODS All patients treated at a single academic tertiary care institution for CSBO from 2016 through 2020 were identified. Inclusion criteria included culture proven CSBO without an otologic or iatrogenic source. Data were extracted via patient chart review and qualitatively analyzed. RESULTS Seven patients were identified with CSBO, 5 male and 2 female. Age ranged from 63 to 87 (average 76). Risk factors included advanced age, diabetes, and history of radiation. The most common presenting symptom was headache (6), followed by otalgia (4). Two patients presented with cranial neuropathies. Diagnosis was facilitated by history and exam (including flexible laryngoscope exam), imaging (MRI), and labs (ESR). All patients received endoscopic biopsy and culture (most commonly polymicrobial, with diverse species). Treatment involved IV antibiotics, with a limited role for surgery. All patients survived and achieved resolution of infection. CONCLUSIONS CSBO remains a diagnostic challenge due to its rarity and vague presenting symptoms that overlap with presentation of sinonasal malignancies. A high index of suspicion is required by the evaluating provider to ensure a timely diagnosis with early treatment in order to limit the significant morbidity which can be associated with this infection. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Rachel B Fenberg
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael J Sylvester
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan - Michigan Medicine, Ann Arbor, MI, USA
| | - Steven Davidson
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Erin L McKean
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan - Michigan Medicine, Ann Arbor, MI, USA
| | - Kyle K VanKoevering
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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McCarty Walsh E, Hanson MB. Fungal Infections of the External Auditory Canal and Emerging Pathogens. Otolaryngol Clin North Am 2023; 56:909-918. [PMID: 37553272 DOI: 10.1016/j.otc.2023.06.010] [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: 08/10/2023]
Abstract
Fungal infections of the external auditory canal can range from common (otomycosis) to life threatening (necrotizing otitis externa). Proper identification of fungal pathogens is necessary to guide appropriate therapy, and a high index of suspicion for fungal causes of ear canal disease is critical. Fungal pathogens may be an especially important cause of ear canal disease in certain populations, including patients with diabetes, patients recently treated with antibiotics, and immunosuppressed patients. Opportunistic fungal infections of the ear canal are an emerging concern.
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Affiliation(s)
- Erika McCarty Walsh
- Department of Otolaryngology, Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Matthew B Hanson
- Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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10
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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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Vatakara A, Damle NA, Khurana A, Sagar S, Kumar R, Verma H. 99mTechnetium-Ubiquicidin Scan with Single-Photon Emission Computed Tomography/Computed Tomography in Skull Base Osteomyelitis. Indian J Nucl Med 2023; 38:297-300. [PMID: 38046968 PMCID: PMC10693375 DOI: 10.4103/ijnm.ijnm_192_22] [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: 12/05/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 12/05/2023] Open
Abstract
Malignant otitis externa (MOE) with skull base osteomyelitis (SBO) is an aggressive infection that predominantly affects elderly, diabetic, or immunocompromised patients, and is associated with high disease-specific mortality. Pseudomonas aeruginosa is the most isolated microorganism. External otitis associated with granulation tissue and pain is the most common presenting feature; a biopsy is obtained to rule out malignancy. A proper consensus is lacking regarding the best imaging modality for early initial diagnosis and follow-up. 99mTechnetium (99mTc)-labeled ubiquicidin (UBI) 29-41 is a bacterial attaching peptide that does not bind to activated leukocytes. We report a case of SBO initially misdiagnosed as a chronic otitis media, but later proved to be a case of MOE. 99mTc methylene diphosphonate bone scan and 99mTc-UBI 29-41 scan with single-photon emission computed tomography/computed tomography scans were performed to corroborate the clinical diagnosis. SBO remains a great challenge due to its increasing prevalence and high morbidity are difficult to diagnose and are often confused with cholesteatoma and neoplastic process. The UBI scan could be an auxiliary noninvasive diagnostic alternative in early diagnosis.
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Affiliation(s)
- Arunraj Vatakara
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | | | - Aditi Khurana
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sambit Sagar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Hitesh Verma
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
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A Unique Case of Purulent Malignant Otitis Externa Causing Community-Acquired Klebsiella Pneumonia Meningitis in a Marshallese Male. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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13
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Urbančič J, Vozel D, Battelino S, Bošnjak R, Kokošar Ulčar B, Matos T, Munda M, Papst L, Steiner N, Vouk M, Zidar N. Atypical Skull-Base Osteomyelitis: Comprehensive Review and Multidisciplinary Management Viewpoints. Trop Med Infect Dis 2023; 8:tropicalmed8050254. [PMID: 37235302 DOI: 10.3390/tropicalmed8050254] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Atypical skull-base osteomyelitis is a rare but fatal disease that usually involves infection of the ethmoid, sphenoid, occipital, or temporal bones that form the skull base. Unlike typical (so-called otogenic), atypical skull-base osteomyelitis has no otogenic cause. Instead, some authors call atypical skull-base osteomyelitis sinonasal, since the infection most often originates from the nose and paranasal sinuses. Diagnosing and treating this disease is challenging. To assist in managing atypical skull-base osteomyelitis, a review of the most recent literature, with patient cases and multidisciplinary perspectives from otolaryngologists, neurosurgeons, radiologists, infectious disease specialists, pathologists, and clinical microbiologists, is provided in this paper.
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Affiliation(s)
- Jure Urbančič
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Domen Vozel
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Saba Battelino
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Roman Bošnjak
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Barbara Kokošar Ulčar
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Tadeja Matos
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Matic Munda
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Lea Papst
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Nejc Steiner
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Matej Vouk
- Department of Radiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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de Souza SAL, Laurindo RSS, Gutfilen-Schlesinger G, Felix F, Amarante Junior JLDM, Gutfilen B. The Use of 99mTc-Mononuclear Leukocyte Scintigraphy for Necrotizing External Otitis Diagnosis. Diagnostics (Basel) 2023; 13:diagnostics13030570. [PMID: 36766675 PMCID: PMC9914623 DOI: 10.3390/diagnostics13030570] [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: 12/22/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Necrotizing external otitis (NEO) is a severe infectious disease in the external acoustic meatus (EAM) and mastoid that may extend to the cranial base. Due to the lack of a gold standard examination technique, the diagnosis is often difficult and delayed. This study aimed to evaluate the sensitivity and specificity of 99mTc-mononuclear leukocyte scintigraphy associated with 99mTc-phytate in suspected NEO compared to 99mTc-MDP and 67Ga-citrate. METHODS A prospective study (32 patients) was conducted between 2011 and 2016. RESULTS At the end, twenty-four patients remained for the study conduction; nineteen had confirmed NEO diagnosis, one had sarcoma, one had EAM cholesteatoma, one had diffuse simple external otitis, and two had an inconclusive diagnosis. 99mTc-mononuclear leukocyte scintigraphy plus 99mTc-phytate was as sensitive as 99mTc-MDP bone scintigraphy (19/19X9/19), and more sensitive than 67Ga scintigraphy (19/19 x 17/19). Regarding specificity, it was superior to bone scintigraphy, 100% × 40% (5/5 × 2/5), and 67Ga scintigraphy, 100% × 20% (5/5 × 1/5). After the infection resolution, all NEO patients had their leukocyte scintigraphy negativized. To the best of our knowledge, this is the first study that evaluates this technique in patients with suspected NEO. CONCLUSIONS 99mTc-mononuclear leukocyte was revealed to be the best option for NEO because of its specificity.
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Affiliation(s)
- Sergio Augusto Lopes de Souza
- Serviço de Otorrinolaringologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
- Correspondence:
| | - Roberta Silveira Santos Laurindo
- Serviço de Otorrinolaringologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
- Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Gabriel Gutfilen-Schlesinger
- Serviço de Otorrinolaringologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Felippe Felix
- Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | | | - Bianca Gutfilen
- Serviço de Otorrinolaringologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
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15
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Predictive factors in treatment response of malignant external otitis. Eur Arch Otorhinolaryngol 2023; 280:159-166. [PMID: 35751693 DOI: 10.1007/s00405-022-07478-5] [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: 02/03/2022] [Accepted: 05/30/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate the prevalence and impact of various predictive factors including diabetes control in malignant external otitis (MEO) treatment response. METHODS In a cross-sectional study on MEO patients, we defined treatment response with three indices; ESR level decrease, hospitalization period, and systemic antifungal drug usage. The impact of diabetes control and other predictive factors on these indices have been evaluated. RESULTS Overall, 164 patients with a mean age of 67.8 ± 9.7 years were included. Cranial nerve involvement was present in 56 patients. Nine patients had immunodeficiency. 19.5% of cases had leukocytosis. Diabetes mellitus was present in 156 patients, suffering for an average of 13.9 ± 8.6 years. The overall mean hemoglobin A1C (HbA1c) level was 8.3% (4.4-12.8%), and the mean fasting blood sugar was 146.4 mg/dl (63-292 mg/dl). 29.3% of patients had good diabetes control before admission (HbA1c < 7%), 54.9% had poor control (7% < HbA1c < 10%) and 15.9% had very poor glycemic control (HbA1c > 10%). The predictive role for the following factors were not statistically significant: age, gender, comorbidities, diabetes, diabetes management method used before and during hospitalization, diabetes duration, leukocytosis, immunodeficiency, fasting blood sugar level, HbA1c level, glycemic control index, and insulin amount. However, CRP level with a mean value of 34.3 mg/L showed a significant correlation with ESR decrease, hospitalization period, and antifungal drug usage. CONCLUSION CRP level could be used as a predictor for the hospitalization period, the need for systemic antifungal and ESR level decrease. It would be helpful to check the CRP level at the time of diagnosis to predict the hospitalization period and the necessity of systemic antifungal management to adjust the treatment strategy.
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16
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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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17
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A Fatal Case of Meningitis Complicating Chronic Otitis Media and Base of Skull Osteomyelitis due to Carbapenemase (OXA-48)-Producing Klebsiella pneumoniae. DR. SULAIMAN AL HABIB MEDICAL JOURNAL 2022. [DOI: 10.1007/s44229-022-00024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AbstractOsteomyelitis of the base of the skull is a rare but life-threatening disease. Although Klebsiella pneumoniae is not a pathogen that is frequently associated with this infection, the clinical course can rapidly progress to meningitis. Here, we describe a case of chronic otitis media, secondary to OXA-48K. pneumoniae, which was complicated by osteomyelitis of the base of the skull and fatal meningitis.
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18
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Jain A, Sharma V, Fatima SS. Malignant Otitis Externa: Diagnostic Dilemma in a Patient with Atypical Presentation. Indian J Otolaryngol Head Neck Surg 2022; 74:3589-3591. [PMID: 36742753 PMCID: PMC9895558 DOI: 10.1007/s12070-020-02073-8] [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: 07/26/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023] Open
Abstract
Malignant otitis externa (MOE) is a relatively rare complication of Otitis externa with a tendency to spread to other parts of temporal bone and skull base. Pseudomonas aeruginosa is the most common pathological agent. It generally occurs in the elderly with poorly controlled diabetes. In this report we present a case of MOE with atypical initial presentation causing immense conundrum in deciphering the diagnosis early.
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Affiliation(s)
- Ashish Jain
- Department of Otolaryngology, Military Hospital Kirkee, Range Hills, Pune, Maharashtra 411020 India
| | - Vikas Sharma
- Department of Otolaryngology, Military Hospital Kirkee, Range Hills, Pune, Maharashtra 411020 India
| | - S. S. Fatima
- Department of Otolaryngology, Military Hospital Kirkee, Range Hills, Pune, Maharashtra 411020 India
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19
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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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20
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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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21
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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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22
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Wahbah Makhoul G, Mobarakai O, Manchandani U, Mobarakai N. A Rare Case of Streptococcus Pneumoniae Causing Malignant Otitis Externa Complicated by Skull Base Osteomyelitis. Cureus 2022; 14:e25692. [PMID: 35812551 PMCID: PMC9258965 DOI: 10.7759/cureus.25692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Skull base osteomyelitis is an aggressive infection involving bones of the skull. It is a rare complication of malignant otitis externa, caused by the contiguous spread of the infection. Patients are mostly elderly with comorbidities that compromise immunity. It is atypical for Streptococcus species to be encountered in basilar skull osteomyelitis. Here we present the case of an 80-year-old male with multiple comorbidities including diabetes mellitus with a two-month history of right ear pain associated with occasional discharge and diminished hearing who was found to have bacteremia and basilar skull osteomyelitis with Streptococcus pneumoniae isolated from blood and otorrhea fluid cultures. This unusual presentation of S. pneumoniae related skull base osteomyelitis could be attributed to an undiagnosed pancreatic cancer at the time of presentation. Malignant otitis externa can progress into invasive disease in the head and neck; almost all cases tend to be caused by Pseudomonas aeruginosa but unusual cases, such as this, can be caused by Streptococcus pneumoniae.
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23
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van der Meer WL, Bayoumy AB, Otten JJ, Waterval JJ, Kunst HP, Postma AA. The association between radiological spreading pattern and clinical outcomes in necrotizing external otitis. J Otol 2022; 17:156-163. [PMID: 35847573 PMCID: PMC9270564 DOI: 10.1016/j.joto.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/24/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives Methods Results Conclusion Level of evidence
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Affiliation(s)
- W. Leentje van der Meer
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, the Netherlands
- Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center+, Radboud University Medical Center, Maastricht/Nijmegen, the Netherlands
| | - Ahmed B. Bayoumy
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, the Netherlands
- Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center+, Radboud University Medical Center, Maastricht/Nijmegen, the Netherlands
- Corresponding author. Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
| | - Josje J. Otten
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, the Netherlands
- Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center+, Radboud University Medical Center, Maastricht/Nijmegen, the Netherlands
| | - Jerome J. Waterval
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, the Netherlands
- Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center+, Radboud University Medical Center, Maastricht/Nijmegen, the Netherlands
| | - Henricus P.M. Kunst
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, the Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, the Netherlands
- Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center+, Radboud University Medical Center, Maastricht/Nijmegen, the Netherlands
| | - Alida A. Postma
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, the Netherlands
- School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands
- Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center+, Radboud University Medical Center, Maastricht/Nijmegen, the Netherlands
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24
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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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25
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Lim JWJ, Hill FCE, Kerr S, Briggs R, McLean T. Diagnostic approach to patients at risk of otogenic skull base osteomyelitis. Acta Otolaryngol 2022; 142:272-279. [PMID: 35382682 DOI: 10.1080/00016489.2022.2057586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Otogenic skull base osteomyelitis (OSBO) is rare and potentially fatal sequelae of otitis externa. Accurate and timely diagnosis is important due to rising incidence, morbidity and costs associated with treatment. Consensus on the diagnostic approach for OSBO has yet to be reached, in particular the utility of imaging modalities. AIMS/OBJECTIVES This study reviews a single institution's high-volume experience of OSBO, with the aim of analysing clinicopathologic features and imaging studies to develop a diagnostic algorithm. MATERIAL AND METHODS A retrospective review of patients admitted with OSBO from 2009 to 2019, was performed. After applying inclusion and exclusion criteria, 103 patients with 106 unique episodes of suspected OSBO were selected. De-identified information including patient demographics, clinicopathologic features and imaging outcomes was recorded and analysed. RESULTS HbA1c ≥ 7% significantly predicted for OSBO in univariate (OR 7.83, 95% CI 1.85-33.16, p = 0.01) and multivariate analyses (OR 5.21, 95% CI 1.05-25.81, p = 0.04). The CT/technetium-99m/gallium-67 combination produced better diagnostic accuracy for OSBO (AUROC 0.96, 95% CI 0.92-1), when compared to a CT/MRI combination (AUROC 0.86, 95% CI 0.79-0.93). CONCLUSIONS AND SIGNIFICANCE Once there is a clinical suspicion for OSBO, diagnosis is established by synthesising results from clinical assessment, pathologic investigations and imaging modalities. The imaging utilised to diagnose OSBO should vary according to the clinical situation and limitations of each modality.
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Affiliation(s)
- Jason Wei Jun Lim
- Department of Otolaryngology, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Fiona C. E. Hill
- Department of Otolaryngology, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Stephen Kerr
- The Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Robert Briggs
- Department of Otolaryngology, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Tim McLean
- Department of Otolaryngology, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
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26
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Shareef M, Ghosn Y, Khdhir M, El Annan T, Alam R, Hourani R. Critical infections in the head and neck: A pictorial review of acute presentations and complications. Neuroradiol J 2022:19714009211059122. [PMID: 35188822 DOI: 10.1177/19714009211059122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Non-traumatic head and neck emergencies include several disease processes such as infectious, inflammatory, and malignant. Infections are among the most common pathological processes that affect the head and neck, and are particularly important due to their acute, severe, and potentially life-threatening nature. Radiologists need to be well acquainted with these entities because any delay or misdiagnosis can lead to significant morbidity and mortality. Having a general understanding of such diseases is crucial, their prevalence, clinical presentation, common causative pathogens, route of spread, potential complications, and multimodality radiological appearance. Furthermore, understanding the relevant anatomy of the region, including the various fascial planes and spaces, is essential for radiologists for accurate image interpretation and assessment of potential complications. Our aim is to review the most common severe infections affecting the head and neck as well as other rare but potentially life-threatening infections. We will also describe their imaging features while focusing on the anatomy of the regions involved and describing their potential complications and treatment options.
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Affiliation(s)
| | - Youssef Ghosn
- Department of Diagnostic Radiology, 66984American University of Beirut, Lebanon
| | - Mihran Khdhir
- Department of Diagnostic Radiology, 66984American University of Beirut, Lebanon
| | - Tamara El Annan
- Department of Diagnostic Radiology, 66984American University of Beirut, Lebanon
| | - Raquelle Alam
- Department of Diagnostic Radiology, 66984American University of Beirut, Lebanon
| | - Roula Hourani
- Department of Diagnostic Radiology, 66984American University of Beirut, Lebanon
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Bala K, Kumari S, Monga R, Sagar P, Thakar A, Sharma SC, Singh UB. Spectrum of mycobacterial pathogens responsible for head and neck tuberculosis-like presentation. Access Microbiol 2022; 3:000304. [PMID: 35024562 PMCID: PMC8749145 DOI: 10.1099/acmi.0.000304] [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: 02/19/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
Tuberculosis (TB) of the head and neck can be contained in the lymph nodes, larynx, oropharynx, salivary glands, nose and paranasal sinuses, ear, skin and skull. Head and neck TB presentations are varied in nature and thus difficult to diagnose. The clinical features, radiological findings, microbiological diagnostic modalities, surgical and medical management and outcomes of nine cases of head and neck TB are discussed in detail here, together with a thorough review of the literature. Patients presented with atypical symptoms such as discharging sinus, ear lobule swelling, otitis media, vision loss and facial weakness, long refractory otorrhoea and granulation tissue in the ear canal. We diagnosed tubercular skull base osteomyelitis (one case) and laryngeal tuberculosis (two cases), mastoid tuberculosis (one case) and non-tubercular mycobacterial infection involving the temporal bone (two cases), sino-nasal region (one case), maxilla (one cases) and ear lobule (one case) over a period of 8 months. All patients were managed successfully with a combination of surgery and a well-planned treatment regimen for non-tuberculous mycobacteria (NTM) or anti-tubercular drugs for TB. All had successful outcomes except one patient with tubercular skull base osteomyelitis who expired before the initiation of anti-tubercular therapy (ATT). High clinical suspicion followed by thorough diagnostic work-up for both TB and NTM would enable early diagnosis and complete treatment.
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Affiliation(s)
- Kiran Bala
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjana Kumari
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rabia Monga
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Prem Sagar
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - S C Sharma
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Urvashi B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Ebied K, Yacoub A, Gamea M, Mahmoud MS. COVID-19-related acute invasive fungal rhinosinusitis: risk factors associated with mortality. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022; 38:137. [PMCID: PMC9589579 DOI: 10.1186/s43163-022-00332-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Acute invasive fungal rhinosinusitis (AIFRS) is a rare aggressive life-threatening infection that affects immunocompromised individuals. Recently, an increase in the incidence of this infection has been reported in patients who have SARS-CoV-2 infection or recently recovered. This study was to assess the outcome and define risk factors that might affect the outcome in SARS-CoV-2-related AIFRS. A prospective observational study included 54 patients diagnosed with SARS-CoV-2-related AIFRS. Controlling the predisposing factors, systemic antifungal, and early surgical debridement was performed. The mortality rate was calculated. Age, sex, underlying risk factors, the extent of the disease, debridement technique, and other biochemical variables were evaluated regarding their impact on survival. Patients were followed up for 3 months. Results Fifty-four patients with a mean age of 48.1 years. Diabetes mellitus was the most common comorbidity affecting 52 patients (96.3%). Intracranial and intraorbital extension had a predictive value for mortality (P value 0.050 and 0.049 respectively). However, only intracranial extension was the independent predictor of mortality. Biochemical variables were higher than the normal range, but only serum ferritin level above 165 ng/ml was an independent predictor of mortality in patients with AIFR. The mortality rate was 38.9%. Conclusion The extent of the disease has a major impact on survival, so early diagnosis of AIFRS within patients infected with SARS-CoV-2 or recently recovered is essential to reduce mortality.
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Affiliation(s)
- Kamal Ebied
- grid.412258.80000 0000 9477 7793Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Abraam Yacoub
- grid.7269.a0000 0004 0621 1570Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Ain Shams University, 38 Abbassia, Next to the Al-Nour Mosque, Cairo, Egypt
| | - Mohamed Gamea
- grid.440875.a0000 0004 1765 2064Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Misr University for Science and Technology, October City, Egypt
| | - Mohammad Salah Mahmoud
- grid.7269.a0000 0004 0621 1570Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Ain Shams University, 38 Abbassia, Next to the Al-Nour Mosque, Cairo, Egypt
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Collins R, Lafford G, Parry L. Paralysis from an ear infection: a severe case of otitis externa leading to acute complete cervical cord syndrome. BMJ Case Rep 2021; 14:e245594. [PMID: 34853046 PMCID: PMC8638130 DOI: 10.1136/bcr-2021-245594] [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] [Accepted: 11/16/2021] [Indexed: 11/04/2022] Open
Abstract
We report a case of a generally fit and well 54-year-old man who presented with a 2-day history of worsening left-sided otorrhea, headache, neck stiffness, vomiting and fever on the background of a 7-week history of otitis externa (OE). His condition progressed dramatically as he developed symptoms consistent with acute complete cervical cord syndrome with radiological evidence of skull base osteomyelitis, parapharyngeal, retropharyngeal and paravertebral abscesses and sigmoid sinus thrombus. Ultimately, he made a significant, although not complete, recovery. This case is unique in demonstrating how OE can develop into a potentially life threatening condition. It emphasises the importance of early diagnosis and treatment of OE, the recognition of 'red flag' symptoms and highlights the importance of a multidisciplinary team approach when managing complex complications of OE.
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Affiliation(s)
- Rachael Collins
- Norwich Medical School, University of East Anglia Norwich Medical School, Norwich, UK
- Department of Otolaryngology, Norfolk and Norwich University Hospital, Norwich, UK
| | - George Lafford
- Department of Plastic Surgery, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Laura Parry
- Department of Ear, Nose and Throat, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
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Khan HA. Necrotising Otitis Externa: A Review of Imaging Modalities. Cureus 2021; 13:e20675. [PMID: 34966623 PMCID: PMC8710300 DOI: 10.7759/cureus.20675] [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] [Accepted: 12/24/2021] [Indexed: 11/25/2022] Open
Abstract
Necrotising Otitis Externa (NOE) has often posed some challenges in view of diagnosis and management by clinicians. One such challenge is the appropriate and timely use of imaging techniques since its use is critical not only in diagnosis but also in determining the extent and resolution of the disease. Hence, doctors in both primary and secondary health care need to be familiar with presenting symptoms while specialists need to be appraised of advances in imagining techniques in diagnosis and management of NOE. Whilst there is a general consensus amongst clinicians on some aspects of management of NOE, there is very limited consensus on the use of imaging modalities. There is no single modality of imaging that can provide a complete picture of diagnosis, disease progression and resolution. This review aims to highlight the strengths and weaknesses of various imaging techniques used in the diagnosis and management of NOE over the years and whether a multi-modal imaging technique at particular stages of the disease may provide better management outcomes.
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Affiliation(s)
- Hammaad A Khan
- Otolaryngology - Head and Neck Surgery, Aintree University Hospital, Liverpool, GBR
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Eweiss AZ, Al-Aaraj M, Sethukumar P, Jama G. Necrotising otitis externa: a serious condition becoming more frequently encountered. J Laryngol Otol 2021; 136:1-5. [PMID: 35317869 DOI: 10.1017/s0022215121003819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Necrotising otitis externa is an aggressive infection of the external ear, which extends to the surrounding bone and soft tissue. In recent years, there has been an apparent increase in the number of patients admitted to our hospital with this condition. METHODS A retrospective review was conducted of all patients admitted to our hospital with necrotising otitis externa between July 2012 and June 2020. RESULTS Among 39 patients included, only 9 were diagnosed in the first four years, and 30 were diagnosed in the last four years. There were 27 males and 12 females, and the mean age was 78.7 years. There were six non-diabetic immunocompetent patients. Cranial nerve palsies developed in 50 per cent of the patients. Disease-related mortality was 7.7 per cent. A favourable outcome was recorded in 66.7 per cent of the patients. CONCLUSION Necrotising otitis externa is associated with high morbidity and mortality. The incidence of the disease is rising in our local geographical area.
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Affiliation(s)
- A Z Eweiss
- ENT Department, Barking Havering and Redbridge University Hospitals, London, UK
- ENT Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - M Al-Aaraj
- ENT Department, Barking Havering and Redbridge University Hospitals, London, UK
| | - P Sethukumar
- ENT Department, Barking Havering and Redbridge University Hospitals, London, UK
| | - G Jama
- ENT Department, Barking Havering and Redbridge University Hospitals, London, UK
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Necrotising otitis externa and how to reduce length of hospital stay: a complete audit cycle of 77 hospital admissions. The Journal of Laryngology & Otology 2021; 136:668-673. [PMID: 34674778 DOI: 10.1017/s002221512100308x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
PURPOSE OF REVIEW Skull base osteomyelitis (SBO) is a challenging entity to diagnose and treat. The goal of this review is to summarize the imaging findings of SBO and present these in the context of recent studies on imaging of SBO. RECENT FINDINGS This review discusses the clinical presentation, pathophysiology and imaging appearances of SBO. The review further emphasizes the results of latest studies on imaging of SBO, and the role of different modalities in diagnosis and evaluation of disease course and treatment response. Brief discussion on differential diagnoses from an imaging standpoint is also included. SUMMARY Various imaging modalities play different and complimentary roles in diagnosis and management of SBO, which are discussed in this review.
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Nosulya EV, Kunelskaya VY, Kim IA, Luchsheva YV. [External otitis: clinical diagnostics and treatment tactics]. Vestn Otorinolaringol 2021; 86:36-40. [PMID: 34269021 DOI: 10.17116/otorino20218603136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To summarize modern data about the epidemiology, etiology, clinical course and diagnosis of otitis externa. MATERIAL AND METHODS Materials of scientific publications included in the Cochrane Library, information bases of the RSCI, MEDLINE, PubMed were used as a data source. The choice of material was carried out according to the keywords: otitis externa, etiology, diagnosis, treatment, local treatment. RESULTS The role of combined drugs in the main etiopathogenetic mechanisms of the external ear inflammatory process is shown. CONCLUSION Analysis of published data from clinical trials indicates the importance of a fixed antibacterial agents and anesthetic combination in increasing the effectiveness of topical therapy for otitis externa.
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Affiliation(s)
- E V Nosulya
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - V Ya Kunelskaya
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - I A Kim
- National Medical Research Center of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - Yu V Luchsheva
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
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Frost J, Samson AD. Standardised treatment protocol for necrotizing otitis externa: retrospective case series and systematic literature review. J Glob Antimicrob Resist 2021; 26:266-271. [PMID: 34273591 DOI: 10.1016/j.jgar.2021.06.015] [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: 02/21/2021] [Revised: 06/13/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES There is currently no consensus on the most effective treatment protocol for necrotizing otitis externa (NOE). This article aims to produce a NOE treatment protocol from the literature and clinical experience. METHODS A total of 26 case series from the literature were reviewed in combination with a retrospective case series of inpatients from Hull University Teaching Hospitals NHS Trust from 2013-2018. Over 5 years, 40 patients were identified, with only 29 being analysed due to unavailable or incomplete case notes. RESULTS In the literature review, the most common bacterial species causing NOE was Pseudomonas aeruginosa. Resistance to ciprofloxacin was prevalent, however multidrug resistance was rare. Ciprofloxacin and ceftazidime were the most widely used antibiotics. No ceftazidime resistance was reported in the literature or in our cohort. The average age of the patients in our cohort was 80 years. Moreover, 62% had either diabetes mellitus or were immunosuppressed. One patient died directly due to NOE-related sepsis. Intravenous ceftazidime monotherapy was mostly used. The duration of treatment was 6-7 weeks, with no relapses documented. CONCLUSION Ceftazidime monotherapy was an effective empirical treatment in our cohort, and a total duration of 6-7 weeks of antibiotics was sufficient. We have created a standardised treatment protocol based on our findings that will need to be validated in a larger cohort of patients.
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Affiliation(s)
- James Frost
- Hull York Medical School, John Hughlings Building, University Road, Heslington, York YO10 5DD, UK; Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, UK; Department of Infection, Hull University Teaching Hospitals, Castle Hill Hospital, Hull, East Yorkshire HU16 5JQ, UK.
| | - Anda D Samson
- Hull York Medical School, John Hughlings Building, University Road, Heslington, York YO10 5DD, UK; Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, UK; Department of Infection, Hull University Teaching Hospitals, Castle Hill Hospital, Hull, East Yorkshire HU16 5JQ, UK
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Morin CD, Déziel E, Gauthier J, Levesque RC, Lau GW. An Organ System-Based Synopsis of Pseudomonas aeruginosa Virulence. Virulence 2021; 12:1469-1507. [PMID: 34180343 PMCID: PMC8237970 DOI: 10.1080/21505594.2021.1926408] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Driven in part by its metabolic versatility, high intrinsic antibiotic resistance, and a large repertoire of virulence factors, Pseudomonas aeruginosa is expertly adapted to thrive in a wide variety of environments, and in the process, making it a notorious opportunistic pathogen. Apart from the extensively studied chronic infection in the lungs of people with cystic fibrosis (CF), P. aeruginosa also causes multiple serious infections encompassing essentially all organs of the human body, among others, lung infection in patients with chronic obstructive pulmonary disease, primary ciliary dyskinesia and ventilator-associated pneumonia; bacteremia and sepsis; soft tissue infection in burns, open wounds and postsurgery patients; urinary tract infection; diabetic foot ulcers; chronic suppurative otitis media and otitis externa; and keratitis associated with extended contact lens use. Although well characterized in the context of CF, pathogenic processes mediated by various P. aeruginosa virulence factors in other organ systems remain poorly understood. In this review, we use an organ system-based approach to provide a synopsis of disease mechanisms exerted by P. aeruginosa virulence determinants that contribute to its success as a versatile pathogen.
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Affiliation(s)
- Charles D Morin
- Centre Armand-Frappier Santé Biotechnologie, Institut National De La Recherche Scientifique (INRS), Laval, Quebec, Canada
| | - Eric Déziel
- Centre Armand-Frappier Santé Biotechnologie, Institut National De La Recherche Scientifique (INRS), Laval, Quebec, Canada
| | - Jeff Gauthier
- Département De Microbiologie-infectiologie Et Immunologie, Institut De Biologie Intégrative Et Des Systèmes (IBIS), Université Laval, Québec City, Quebec, Canada
| | - Roger C Levesque
- Département De Microbiologie-infectiologie Et Immunologie, Institut De Biologie Intégrative Et Des Systèmes (IBIS), Université Laval, Québec City, Quebec, Canada
| | - Gee W Lau
- Department of Pathobiology, University of Illinois at Urbana-Champaign, Urbana, IL, US
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Selvamalar V, Othman NAN, Daud MK. A Case Series of Malignant Otitis Externa Mimicking Malignancy. ACTA MEDICA (HRADEC KRÁLOVÉ) 2021; 64:36-41. [PMID: 33855957 DOI: 10.14712/18059694.2021.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Malignant otitis externa is an inflammation of the external auditory canal with preceding osteomyelitis of the temporal bone and the adjacent structures that could be potentially lethal. Malignant otitis externa may present with cranial nerve involvements and massive spread of disease mimicking nasopharyngeal carcinoma or any other malignancies on imaging. Two elderly patients who presented with severe otalgia and significant facial nerve palsy and lower cranial nerve palsies showing extensive spread of disease are reported in this case series. They both had resolution of disease after a prolonged course of antibiotics and cortical mastoidectomy for disease clearance in one of them.
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Affiliation(s)
- Vengathajalam Selvamalar
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Nik Adilah Nik Othman
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. .,Hospital University Sains Malaysia, Health Campus, Kubang Kerian, 16150, Kelantan, Malaysia.
| | - Mohd Khairi Daud
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Hospital University Sains Malaysia, Health Campus, Kubang Kerian, 16150, Kelantan, Malaysia
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Diabetes and glycemic control in necrotizing otitis externa (NOE). Eur Arch Otorhinolaryngol 2021; 279:1269-1275. [PMID: 33792784 DOI: 10.1007/s00405-021-06772-y] [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: 11/29/2020] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Although the association between necrotizing otitis externa (NOE) and diabetes mellitus (DM) is well known, there is little knowledge in regards to the effects of DM and glycemic control on the outcome of NOE. The aim of the study was to determine the effects of DM duration and glycemic control, and in-hospital glycemic control on NOE severity. METHODS A retrospective case series analysis, including all patients hospitalized between 1990 and 2018 due to NOE were included. Data collected included NOE disease characteristics, duration of DM, DM-associated comorbidities, glycated hemoglobin (HbA1c), urine microalbumin and in-hospital blood glucose measurements. Disease severity was defined based on duration of hospitalization (above or below 20 days) and need for surgery. RESULTS Eighty-nine patients were included in the study. Eighty-three patients (94.3%) had DM. Preadmission HbA1c was 8.13% (5.8-12.6%). Forty-nine patients (65.5%) had mean blood glucose of ≥ 140 mg/dL and 26 (34.5%) had ≤ 140 mg/dL. DM duration was 157.88 months among NOE patients who required surgery, and 127.6 months among patients who were treated conservatively (p value 0.25). HbA1c in patients hospitalized < 20 days was 7.6%, and 8.7% among NOE hospitalized ≥ 20 days (p value 0.027). Seven patients with mean blood glucose of ≤ 140 mg/dL had Pseudomonas Aeruginosa (PA-NOE) (26.7%), in comparison to 25 (51.0%) with mean blood glucose measurement of ≥ 140 mg/dL (p = 0.045). CONCLUSIONS HbA1c at admission is associated with longer hospitalization duration among NOE patients. Mean blood glucose during hospitalization was associated with a higher likelihood of PA infection, however, it had no effect on disease outcome.
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Chapman PR, Choudhary G, Singhal A. Skull Base Osteomyelitis: A Comprehensive Imaging Review. AJNR Am J Neuroradiol 2021; 42:404-413. [PMID: 33478944 DOI: 10.3174/ajnr.a7015] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022]
Abstract
Skull base osteomyelitis is a relatively rare condition, generally occurring as a complication of advanced otologic or sinus infection in immunocompromised patients. Skull base osteomyelitis is generally divided into 2 broad categories: typical and atypical. Typical skull base osteomyelitis occurs secondary to uncontrolled infection of the temporal bone region, most often from necrotizing external otitis caused by Pseudomonas aeruginosa in a patient with diabetes. Atypical skull base osteomyelitis occurs in the absence of obvious temporal bone infection or external auditory canal infection. It may be secondary to advanced sinusitis or deep face infection or might occur in the absence of a known local source of infection. Atypical skull base osteomyelitis preferentially affects the central skull base and can be caused by bacterial or fungal infections. Clinically, typical skull base osteomyelitis presents with signs and symptoms of otitis externa or other temporal bone infection. Both typical and atypical forms can produce nonspecific symptoms including headache and fever, and progress to cranial neuropathies and meningitis. Early diagnosis can be difficult both clinically and radiologically, and the diagnosis is often delayed. Radiologic evaluation plays a critical role in the diagnosis of skull base osteomyelitis, with CT and MR imaging serving complementary roles. CT best demonstrates cortical and trabecular destruction of bone. MR imaging is best for determining the overall extent of disease and best demonstrates involvement of marrow space and extraosseous soft tissue. Nuclear medicine studies can also be contributory to diagnosis and follow-up. The goal of this article was to review the basic pathophysiology, clinical findings, and key radiologic features of skull base osteomyelitis.
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Affiliation(s)
- P R Chapman
- From the Section of Neuroradiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - G Choudhary
- From the Section of Neuroradiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - A Singhal
- From the Section of Neuroradiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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A Case Report of Complete Resolution of Auricular Mucormycosis in an 18-Month-Old Diabetic Child. Case Rep Otolaryngol 2021; 2021:6618191. [PMID: 33954001 PMCID: PMC8068535 DOI: 10.1155/2021/6618191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/02/2021] [Accepted: 02/11/2021] [Indexed: 01/18/2023] Open
Abstract
Background One of the most rare but deadly types of infectious fungal infection is Mucormycosis. All the cases reported with this type of infection are immunocompromised individuals. The challenge of early detection and intervention makes it one of the high mortality rates among other infectious diseases. Case Report. We report an 18-month-old girl with undiagnosed diabetes presented with a very aggressive form of necrotic infection of the ear auricle with facial nerve palsy. Using a series of magnetic resonance imaging, antibiotics, and high clinical suspicion, a diagnosis was established, and the patient was sent to the operation theatre for surgical debridement. Monthly follow-ups showed improvement of the facial palsy, and a plan for artificial auricle is set to occur in the following months before the age of five. Discussion. Mucormycosis is considered a very fatal and aggressive infection that has a very high mortality rate in immunocompromised patients. Early detection of such cases with an array of magnetic resonance imaging (MRI) and computed tomography (CT) is crucial in early treatment. Early aggressive surgical debridement and empirical coverage of bacterial, viral, and fungal infections can also alleviate the chances of preventing any secondary infection to develop in such cases. Conclusion A combination of antifungal, antibiotic, and antiviral with timely surgical intervention improved the patient with complete resolution of the facial nerve palsy and no further recurrence of the infection.
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Abuabat A, Tatwani T. Skull Base Osteomyelitis With Facial and Trigeminal Nerve Involvement Secondary to Otitis Media. Cureus 2021; 13:e13394. [PMID: 33758695 PMCID: PMC7977780 DOI: 10.7759/cureus.13394] [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] [Indexed: 11/08/2022] Open
Abstract
Skull base osteomyelitis (SBO) is a rare condition that is associated with high morbidity rates. It is most commonly caused by an infection in the external part of the ear that eventually spreads to the skull base and related structures. To our knowledge, reports in the literature concerning atypical causes of SBO (e.g., otitis media) have been scarce. In this report, we present a rare case of an elderly diabetic patient who presented with unilateral SBO originating from an infection in the middle ear. This patient also had ipsilateral facial weakness and trismus, indicating a spread of the infection to the facial and trigeminal cranial nerves.
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Affiliation(s)
- Abdulaziz Abuabat
- Family Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Tariq Tatwani
- Otolaryngology, Prince Sultan Military Medical City, Riyadh, SAU
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Chávez-Reyes J, Escárcega-González CE, Chavira-Suárez E, León-Buitimea A, Vázquez-León P, Morones-Ramírez JR, Villalón CM, Quintanar-Stephano A, Marichal-Cancino BA. Susceptibility for Some Infectious Diseases in Patients With Diabetes: The Key Role of Glycemia. Front Public Health 2021; 9:559595. [PMID: 33665182 PMCID: PMC7921169 DOI: 10.3389/fpubh.2021.559595] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 01/12/2021] [Indexed: 01/08/2023] Open
Abstract
Uncontrolled diabetes results in several metabolic alterations including hyperglycemia. Indeed, several preclinical and clinical studies have suggested that this condition may induce susceptibility and the development of more aggressive infectious diseases, especially those caused by some bacteria (including Chlamydophila pneumoniae, Haemophilus influenzae, and Streptococcus pneumoniae, among others) and viruses [such as coronavirus 2 (CoV2), Influenza A virus, Hepatitis B, etc.]. Although the precise mechanisms that link glycemia to the exacerbated infections remain elusive, hyperglycemia is known to induce a wide array of changes in the immune system activity, including alterations in: (i) the microenvironment of immune cells (e.g., pH, blood viscosity and other biochemical parameters); (ii) the supply of energy to infectious bacteria; (iii) the inflammatory response; and (iv) oxidative stress as a result of bacterial proliferative metabolism. Consistent with this evidence, some bacterial infections are typical (and/or have a worse prognosis) in patients with hypercaloric diets and a stressful lifestyle (conditions that promote hyperglycemic episodes). On this basis, the present review is particularly focused on: (i) the role of diabetes in the development of some bacterial and viral infections by analyzing preclinical and clinical findings; (ii) discussing the possible mechanisms by which hyperglycemia may increase the susceptibility for developing infections; and (iii) further understanding the impact of hyperglycemia on the immune system.
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Affiliation(s)
- Jesús Chávez-Reyes
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - Carlos E Escárcega-González
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico.,Centro de Investigación en Biotecnología y Nanotecnología, Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Erika Chavira-Suárez
- Unidad de Vinculación Científica de la Facultad de Medicina, Universidad Nacional Autónoma de México en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | - Angel León-Buitimea
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico.,Centro de Investigación en Biotecnología y Nanotecnología, Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Priscila Vázquez-León
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - José R Morones-Ramírez
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico.,Centro de Investigación en Biotecnología y Nanotecnología, Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Carlos M Villalón
- Departamento de Farmacobiología, Cinvestav-Coapa, Mexico City, Mexico
| | - Andrés Quintanar-Stephano
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - Bruno A Marichal-Cancino
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
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Devaraja K, Nayak DR. Malignant otitis externa with subsequent internal jugular vein thrombosis and hypoglossal palsy: a report and review of literature. J Otol 2020; 15:112-116. [PMID: 32884563 PMCID: PMC7451676 DOI: 10.1016/j.joto.2020.01.004] [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: 09/22/2019] [Revised: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 11/29/2022] Open
Abstract
Inflammation of a part or whole of the temporal bone and surrounding soft tissue is termed as malignant otitis externa, which typically spreads to skull base to involve cranial nerves VII. Rarely can it also effect one or more of cranial nerves IX, X, XI, and XII. We present a case of malignant otitis externa which presented with symptomatic palsy of IX and XII nerves sparing the VII cranial nerve. The patient though later on had internal jugular vein thrombosis, which we presume is due to the involvement of the parapharyngeal space that prompted us to reconsider the diagnosis, and later on, to aggravate the therapy. With proper blood sugar control and appropriate long term antibiotics, not only that the patient is disease free at one year follow up, but the cranial nerve deficits also recovered. Apart from sharing the clinical and management details of this patient, we have reviewed the relevant literature in the discussion, which has shed some light onto some of the interesting facts about this condition and its prognosis.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, 576104, India
| | - Dipak Ranjan Nayak
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, 576104, India
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Di Lullo AM, Russo C, Piroli P, Petti A, Capriglione P, Cantone E, Motta G, Iengo M, Elefante A, Cavaliere M. Malignant Otitis External: Our Experience and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925060. [PMID: 32808601 PMCID: PMC7458700 DOI: 10.12659/ajcr.925060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Malignant external otitis (MEO) is an invasive infection that can involve the external auditory canal and the skull base up to the contiguous soft tissues. Considering the changing face of MEO, we reviewed cases of MEO treated in our Ear Nose Throat (ENT) clinic - University Federico II of Naples between 2018 and 2019 to evaluate the current epidemiology of the condition and to assess the state of art on diagnosis, therapeutic and follow-up management in our patients. CASE REPORT We present the cases of three male patients with Type 2 diabetes mellitus who complained of long-lasting otorrhea and pain, with clinical suspicion of MEO. In all cases, ear swab was positive for Pseudomonas aeruginosa. All our patients received a 6-week course of intravenous ciprofloxacin, piperacillin, and tazobactam, with rapid clinical symptoms improvement and complete recovery at 1-year follow-up. CONCLUSIONS MEO is difficult to treat due to the lack of standardized care guidelines. Patients with MEO often present with severe otalgia, edema, otorrhea, and facial nerve paralysis. Clinicians must suspect MEO in elderly diabetic and immunocompromised patients with persistent otalgia after external otitis. Imaging (computed tomography and magnetic resonance imaging) can play synergistic roles in the management of MEO. To evaluate eradication of the disease, clinicians have to assess clinical symptoms and signs as well as radiological imaging and inflammatory markers.
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Affiliation(s)
- Antonella M Di Lullo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology - Head and Neck Surgery Unit, University of Naples Federico II, Naples, Italy.,CEINGE - Advanced Biotechnology, Naples, Italy
| | - Camilla Russo
- Department of Advance Biomedical Sciences, Neuroradiology Unit, University of Naples Federico II, Naples, Italy
| | - Piera Piroli
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology - Head and Neck Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Alessandra Petti
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology - Head and Neck Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Pasquale Capriglione
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology - Head and Neck Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology - Head and Neck Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Gaetano Motta
- Department of Mental and Physical Health and Preventive Medicine, Otorhinolaryngology - Head and Neck Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Maurizio Iengo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology - Head and Neck Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Andrea Elefante
- Department of Advance Biomedical Sciences, Neuroradiology Unit, University of Naples Federico II, Naples, Italy
| | - Michele Cavaliere
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Otorhinolaryngology - Head and Neck Surgery Unit, University of Naples Federico II, Naples, Italy
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Krishnamoorthy M, Othman NAN, Hassan NEB, Hitam SB. Candida Skull Base Osteomyelitis: a Case Report and Literature Review. ACTA MEDICA (HRADEC KRÁLOVÉ) 2020; 63:82-85. [PMID: 32771074 DOI: 10.14712/18059694.2020.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Skull base osteomyelitis (SBO) also commonly known as malignant otitis externa was first described by Meltzer and Kelemen in 1959. Prior to the advent of the antibiotic era, this disease carried a poor prognosis with significant morbidity. It often proved fatal with mortality rates as high as 50%. Commonly seen in the immunocompromised patients, diabetes mellitus is an important associated comorbidity in the pathophysiologic development of this disease. Treatment is instituted by medical therapy with surgery having a limited role. Surgical intervention has a limited role, for example, in fungal SBO. Such cases may require local debridement and intraoperative tissue biopsies for histopathologic confirmation. This is to demonstrate fungal invasion into the skull base, as well as to exclude other sinister differential diagnoses like squamous cell carcinoma of temporal bone. In this case report, we present a rare case of candida SBO and the literature review.
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Affiliation(s)
- Madhusudhan Krishnamoorthy
- Department of Otorhinolaryngology and Head & Neck Surgery, Hospital Universiti Sains Malaysia, School of Medical Sciences, Kubang Kerian, Kelantan, Malaysia.
| | - Nik Adilah Nik Othman
- Department of Otorhinolaryngology and Head & Neck Surgery, Hospital Universiti Sains Malaysia, School of Medical Sciences, Kubang Kerian, Kelantan, Malaysia
| | - Nor Eyzawiah Binti Hassan
- Department of Otorhinolaryngology and Head & Neck Surgery, Hospital Ampang, Selangor, Malaysia.,Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia (USIM), Pandan Indah, Selangor, Malaysia
| | - Shahrul Bin Hitam
- Department of Otorhinolaryngology and Head & Neck Surgery, Hospital Ampang, Selangor, Malaysia
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Long DA, Koyfman A, Long B. An emergency medicine-focused review of malignant otitis externa. Am J Emerg Med 2020; 38:1671-1678. [DOI: 10.1016/j.ajem.2020.04.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022] Open
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Abstract
OBJECTIVE To assess for changes in trends of the disease process, management, and outcomes of necrotizing otitis externa (NOE) over the last decade. DATA SOURCES Articles in English, published between January 2011 and June 2019, were searched in PubMed, Scopus, Web of Science, ScienceDirect, and the Cochrane Database. STUDY SELECTION Inclusion criteria: 1) reported evidence of NOE, 2) details on patient demographic and underlying medical disorder, 3) details on treatments, 4) documented outcomes, and 5) greater than 10 cases. DATA EXTRACTION Study demographics, underlying conditions, infectious etiology, treatments, signs and symptoms, and outcomes. DATA SYNTHESIS Ten studies, totalling 284 patients with a mean age of 67.8 years, were included. The time period of collected patient data ranged from 2000 to 2018. Temporal subgroup analysis was conducted before and after 2009. Cure rate was lower in the post-2009 group (76.0 versus 94.1%, p < 0.01) while disease-specific mortality remained stable. Increases in proportions of diabetes and culture negative results (p < 0.01) were also observed in this latter group. Rate of extensive surgery and the use of ciprofloxacin decreased (p < 0.01), while the use of ceftazidime increased in the post-2009 group (p < 0.01). CONCLUSION A decrease in cure rate of NOE patients was observed in the setting of an increase in prevalence of diabetes. Various antipseudomonal agents are being used and an increase in culture negative results is seen.
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A retrospective review and multi-specialty, evidence-based guideline for the management of necrotising otitis externa. The Journal of Laryngology & Otology 2020; 134:487-492. [PMID: 32498757 DOI: 10.1017/s0022215120001061] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Necrotising otitis externa is a progressive infection of the external auditory canal which extends to affect the temporal bone and adjacent structures. Progression of the disease process can result in serious sequelae, including cranial nerve palsies and death. There is currently no formal published treatment guideline. OBJECTIVE This study aimed to integrate current evidence and data from our own retrospective case series in order to develop a guideline to optimise necrotising otitis externa patient management. METHODS A retrospective review of necrotising otitis externa cases within NHS Lothian, Scotland, between 2013 and 2018, was performed, along with a PubMed review. RESULTS Prevalent presenting signs, symptoms and patient demographic data were established. Furthermore, features of cases associated with adverse outcomes were defined. A key feature of the guideline is defining at-risk patients with initial intensive treatment. Investigations and outcomes are assessed and treatment adjusted appropriately. CONCLUSION This multi-departmental approach has facilitated the development of a succinct, systematic guideline for the management of necrotising otitis externa. Initial patient outcomes appear promising.
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Krebbers I, van de Goor RM, van Kampen RJ, Theunissen PH, Bergshoeff VE. An unexpected, invasive disease of the mastoid bone and external auditory canal. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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