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Go BC, Wong K, Eliades SJ, Brant JA, Bigelow DC, Ruckenstein MJ, Hwa TP. Reassessing the Utility of Surgical Intervention for Skull Base Osteomyelitis: A 16-Year Experience. Otolaryngol Head Neck Surg 2024; 171:197-204. [PMID: 38344847 DOI: 10.1002/ohn.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/04/2024] [Accepted: 01/13/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE The role of surgery in lateral skull base osteomyelitis (SBO) is controversial. Surgical intervention is often requested by consulting services in the interest of additional culture data to inform medical management. However, whether surgery alters subsequent antibiotic treatment or modifies disease outcome remains unknown. The aim of this study was to investigate the role of surgical intervention in the treatment of SBO by (1) comparing nonsurgical and surgical culture data and (2) assessing clinical outcomes and treatment course following surgical intervention. STUDY DESIGN Retrospective. SETTING Tertiary care center. METHODS The electronic record was queried for all patients with SBO who presented to a single institution over a 16-year period (2007-2023). Information recorded included history and exam, bedside and intraoperative culture data, antibiotic course, and disease outcomes. Primary outcome measures included change in medical management based on intraoperative cultures, recurrence rates, and mortality rates. RESULTS Forty patients (41 ears, average age 73 ± 13 years) met inclusion criteria. Out of 13 (32%) patients who underwent surgical intervention, one intraoperative culture changed the antibiotic course due to identification of resistance to the original antibiotic used. Surgery did not demonstrate a benefit in overall mortality (23% vs 18%, P = 0.36) or facial nerve function (33% vs 50%, P = 0.56) compared to medical management, and was associated with increased recurrence rates (54% vs 11%, P = 0.05). CONCLUSION Surgical cultures rarely changed antibiotic selection. Surgical debridement in treatment-refractory SBO was also not associated with improvement in recurrence or mortality rates, though this may reflect underlying differences in disease severity.
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Affiliation(s)
- Beatrice C Go
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin Wong
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven J Eliades
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jason A Brant
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Douglas C Bigelow
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael J Ruckenstein
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tiffany P Hwa
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Krawiec E, Brenet E, Truong F, Nguyen Y, Papthanassiou D, Labrousse M, Dubernard X. Epidemiology and risk factors for extension of necrotizing otitis externa. Eur Arch Otorhinolaryngol 2024; 281:2383-2394. [PMID: 38499694 DOI: 10.1007/s00405-024-08549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Necrotizing otitis externa (OEN) is an aggressive and morbid infection of the external acoustic meatus. What are the risk factors for OEN extension? METHODS French monocentric retrospective study (2004-2021), including patients with OEN defined by the association of an inflamed EAM, a positive nuclear imaging, the presence of a bacteriological sample and the failure of a well-followed local and/or general antibiotic treatment. OEN was extensive if it was associated with vascular or neurological deficits, if nuclear imaging fixation and/or bone lysis extended beyond the tympanic bone. RESULTS Our population (n = 39) was male (74%), type 2 diabetic (72%), aged 75.2 years and pseudomonas aeruginosa was found in 88% of cases. Complications for 43% of patients were extensive fixation on nuclear imaging, for 21% of them the presence of extensive bone lysis, for 13% the appearance of facial palsy, for 5.3% the presence hypoglossal nerve palsy and for 2.5% the presence of thrombophlebitis or other nerves palsies. 59% of our population had extensive OEN. The diagnosis of the extensive OEN was made 22 days later (p = 0.04). The clinical presentation was falsely reassuring due to easier identification of the tympanic membrane (70% vs 46%, p = 0.17) but associated with periauricular oedema (42% vs 0%), bone exposure (16% vs 0%) and a temporomandibular joint pain (41% vs 12%). CONCLUSION Delayed treatment of OEN, identification of clinical bone lysis, especially when the tympanic membrane is easily visualized, and the presence of unbalanced diabetes are potential risk factors for extension of OEN.
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Affiliation(s)
- Elise Krawiec
- Departments of Oto-Rhino-Laryngology, University Hospital of Reims, Rue du Général Koenig, 51100, Reims, France
| | - Esteban Brenet
- Departments of Oto-Rhino-Laryngology, University Hospital of Reims, Rue du Général Koenig, 51100, Reims, France
| | - France Truong
- Departments of Oto-Rhino-Laryngology, University Hospital of Reims, Rue du Général Koenig, 51100, Reims, France
| | - Yohan Nguyen
- Department of Internal Medicine, Infectious Diseases and Clinical Immunology, University Hospital of Reims, Reims, France
| | | | - Marc Labrousse
- Departments of Oto-Rhino-Laryngology, University Hospital of Reims, Rue du Général Koenig, 51100, Reims, France
| | - Xavier Dubernard
- Departments of Oto-Rhino-Laryngology, University Hospital of Reims, Rue du Général Koenig, 51100, Reims, France.
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Vosbeek EGM, Straatman LV, Braat AJAT, de Keizer B, Thomeer HGXM, Smit AL. Management and Outcomes of Necrotizing Otitis Externa: A Retrospective Cohort Study in a Tertiary Referral Center. OTOLOGY & NEUROTOLOGY OPEN 2023; 3:e042. [PMID: 38516544 PMCID: PMC10950167 DOI: 10.1097/ono.0000000000000042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 10/09/2023] [Indexed: 03/23/2024]
Abstract
Objectives Necrotizing otitis externa (NOE) is a rare infection of the ear that causes osteomyelitis. We aimed to evaluate treatment outcomes and the role of imaging in diagnosing and monitoring disease resolution in a single-center study of patients with NOE. Methods In this retrospective cohort study, patients with NOE who were diagnosed and treated in a tertiary otology center in Utrecht, The Netherlands, between January 1, 2013 and August 1, 2022, were included. Data were retrieved from the medical records on demographics, symptoms, physical and diagnostic findings, type and duration of treatment, and course of disease. Results A total of 24 cases were included. Patients were often elderly (mean age = 75 years) and diabetic (88%). Pseudomonas aeruginosa was the most commonly found microorganism (63%). Twenty-two cases (92%) received intravenous antibiotic treatment, and 7 cases (29%) received additional systemic antifungal treatment. The mean duration of systemic treatment was 29 weeks. In 20 out of 22 cases (91%), imaging was used to determine the end point of treatment. None of the cases with a total resolution of disease activity (n = 5) on 18F-fluorodeoxyglucose-positron emission tomography-computed tomography imaging at the time of cessation of therapy showed clinical relapse, compared with 1 out of 4 cases on gallium single-photon emission computerized tomography. Conclusion Based on the experience from our center, we demonstrated that patients with NOE can successfully be treated with prolonged systemic treatment. Molecular imaging is reasonably successful for disease evaluation and decision-making on the eradication of disease.
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Affiliation(s)
- Eleonora G M Vosbeek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Louise V Straatman
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Adriana L Smit
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
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Azeez TA, Adeagbo AK. The Association Between Malignant Otitis Externa and Diabetes Mellitus in Africa: A Systematic Review. Indian J Otolaryngol Head Neck Surg 2023; 75:3277-3287. [PMID: 37974885 PMCID: PMC10645783 DOI: 10.1007/s12070-023-03939-3] [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: 03/27/2023] [Accepted: 06/06/2023] [Indexed: 11/19/2023] Open
Abstract
Diabetes mellitus is one of the risk factors for malignant otitis externa. There are very few studies on the disease in Africa and there is a need to pool the prior studies to highlight the characteristics of the disease. The study type is a systematic review and the PRISMA guidelines were followed. Using the appropriate terms, relevant medical databases were systematically searched. Thirty-two studies met the eligibility criteria with a total sample size of 848, who were mainly elderly. Diabetes mellitus was present in 94% of the participants. Average duration of diabetes diagnosis in the participants was 12.4 years. The pooled HbA1c was 9.8%. The most common symptoms were otalgia (96.1%), otorrhoea (75.8%) and hearing loss (56.1%). Pseudomonas was the most common isolate (72%). Fluoroquinolones and the 3rd-generation cephalosporins were the preferred antibiotics. The pooled cure rate from antimicrobial usage was 76.2%. In addition to medications, 24.6% of the affected individuals required debridement. About 1.6% of the participants died from malignant otitis externa. Malignant otitis externa is associated with poorly controlled diabetes. Pseudomonas is the most common cause and a significant proportion gets cured with prolonged antibiotherapy.
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Affiliation(s)
- Taoreed Adegoke Azeez
- Department of Medicine, Reddington Multi-Specialist Hospital, 12, Idowu Martins Street, Victoria Island, Lagos, Nigeria
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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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Costa MB, Onishi ET. Necrotizing Otitis Externa: A Proposal for Diagnostic and Therapeutic Approach. Int Arch Otorhinolaryngol 2023; 27:e706-e712. [PMID: 37876706 PMCID: PMC10593509 DOI: 10.1055/s-0042-1758719] [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: 08/09/2022] [Accepted: 09/04/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Necrotizing otitis externa has a high impact on the quality of life of patients and has shown a significant increase in its incidence in recent years. There has been a change in the profile of affected patients and a lack of consensus on the management of these patients. Objective To develop a practical and effective care protocol to standardize the diagnostic and therapeutic management of necrotizing otitis externa. Methods A retrospective cohort study of necrotizing otitis externa patients between January 2015 and December 2020. Results There were 34 patients with two bilateral cases, totaling 36 ears. The mean age was 68.5, with a higher prevalence of males (76%). Diabetes was present in 97% of the samples. The involvement of cranial pairs was identified in 35% of the sample. Pseudomonas aeruginosa was the most frequent pathogen isolated, found in 50% of the cases. Among the cultures with bacterial agents isolated, 35% showed resistance to ciprofloxacin. The most frequent exam was computed tomography (94%). Hospital admission was indicated for 31 patients (91%), and ceftazidime was the most prescribed drug (35.5%). There were 11 recurrences (32%), and 12 patients (35%) had complications during treatment. Among the unfavorable outcomes, 12% persisted with some degree of peripheral facial paralysis, 6% maintained dysphagia, and 9% died of the disease. Conclusions The present study developed a diagnostic and therapeutic protocol for the effective management of necrotizing otitis externa. This protocol is a dynamic tool and should be revised and updated as new demands emerge during its implementation.
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Affiliation(s)
- Marília Batista Costa
- Department of Otorhinolaryngology - Head and Neck Surgery, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, SP, Brazil
| | - Ektor Tsuneo Onishi
- Department of Otorhinolaryngology - Head and Neck Surgery, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, SP, Brazil
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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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Tsilivigkos C, Avramidis K, Ferekidis E, Doupis J. Malignant External Otitis: What the Diabetes Specialist Should Know-A Narrative Review. Diabetes Ther 2023; 14:629-638. [PMID: 36897495 PMCID: PMC10064349 DOI: 10.1007/s13300-023-01390-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
AIMS Malignant external otitis (MEO) is a special type of external otitis associated with extensive inflammation and osteomyelitis. It is believed to originate from the external auditory meatus and advance regionally to the soft tissues and the bone, eventually involving the skull base. Pseudomonas aeruginosa and diabetes mellitus are factors commonly involved in the pathogenesis of MEO. Although its treatment has changed considerably during the last decades, morbidity and mortality of the disease remain high. Our aim was to review basic aspects of MEO, a disease unknown until 1968, which attracts great interest among Ears, Nose and Throat (ENT), diabetes and infectious diseases specialists. METHODS AND RESULTS In this narrative review we mainly include relevant papers written in English or with an English abstract. We searched PubMed and Google Scholar, using the keywords malignant external otitis, malignant otitis externa, necrotizing external otitis, skull base osteomyelitis, diabetes mellitus and surgery up to July 2022. Some of the most recent articles, with specific references to earlier articles and a book reference regarding the pathophysiology, diagnosis and treatment of MEO and its relationship to diabetes mellitus, were included. CONCLUSION MEO is not an uncommon disease and is principally treated by ENT surgeons. Nevertheless, diabetes specialists should be aware of the disease presentation and management, since they will often encounter patients with undiagnosed MEO or will need to manage glucose levels in patients hospitalized with the disease.
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Affiliation(s)
- Christos Tsilivigkos
- First Department of Otolaryngology, Hippokration General Hospital, National and Kapodistrian University of Athens, 15772, Athens, Greece.
| | - Konstantinos Avramidis
- Second Department of Internal Medicine, Hippokration General Hospital, 15772, Athens, Greece
| | - Eleftherios Ferekidis
- First Department of Otolaryngology, Hippokration General Hospital, National and Kapodistrian University of Athens, 15772, Athens, Greece
| | - John Doupis
- Department of Internal Medicine and Diabetes, Salamis Naval and Veterans Hospital, Salamis Naval Base, 18900, Salamis Island, Greece
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Takata J, Hopkins M, Alexander V, Bannister O, Dalton L, Harrison L, Groves E, Kanona H, Jones GL, Mohammed H, Andersson MI, Hodgson SH. Systematic review of the diagnosis and management of necrotising otitis externa: Highlighting the need for high-quality research. Clin Otolaryngol 2023; 48:381-394. [PMID: 36759416 DOI: 10.1111/coa.14041] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/30/2022] [Accepted: 01/28/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES To present a systematic review and critical analysis of clinical studies for necrotising otitis externa (NOE), with the aim of informing best practice for diagnosis and management. DESIGN Medline, Embase, Cochrane Library and Web of Science were searched from database inception until 30 April 2021 for all clinical articles on NOE. The review was registered on PROSPERO (ID: CRD42020128957) and conducted in accordance with PRISMA guidelines. RESULTS Seventy articles, including 2274 patients were included in the final synthesis. Seventy-three percent were retrospective case series; the remainder were of low methodological quality. Case definitions varied widely. Median patient age was 69.2 years; 68% were male, 84% had diabetes and 10% had no reported immunosuppressive risk factor. Otalgia was almost universal (96%), with granulation (69%) and oedema (76%) the commonest signs reported. Pseudomonas aeruginosa was isolated in 62%, but a range of bacterial and fungal pathogens were reported and 14% grew no organism. Optimal imaging modality for diagnosis or follow-up was unclear. Median antimicrobial therapy duration was 7.2 weeks, with no definitive evidence for optimal regimens. Twenty-one percent had surgery with widely variable timing, indication, or procedure. One-year disease-specific mortality was 2%; treatment failure and relapse rates were 22% and 7%, respectively. CONCLUSION There is a lack of robust, high-quality data to support best practice for diagnosis and management for this neglected condition. A minimum set of reporting requirements is proposed for future studies. A consensus case definition is urgently needed to facilitate high-quality research.
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Affiliation(s)
- Junko Takata
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.,Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Michael Hopkins
- Department of Ear, Nose and Throat Surgery, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Victoria Alexander
- Department of Ear, Nose and Throat Surgery, St George's University Hospital NHS Trust, London, UK
| | - Oliver Bannister
- Department of Infection, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Modernising Medical Microbiology, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lucy Dalton
- Department of Ear, Nose and Throat Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Laura Harrison
- Department of Ear, Nose and Throat Surgery, Royal Berkshire Hospital, Reading, UK
| | - Emily Groves
- Department of General Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Hala Kanona
- Department of Ear, Nose and Throat Surgery, The Royal National Ear Nose and Throat and Eastman Dental Hospital, University College London Hospitals NHS Trust, London, UK
| | | | - Hassan Mohammed
- Department of Ear, Nose and Throat, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Monique I Andersson
- Department of Infection, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Susanne H Hodgson
- Department of Infection, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Biochemistry, University of Oxford, Oxford, UK
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Freeman MH, Perkins EL, Tawfik KO, O'Malley MR, Labadie RF, Haynes DS, Bennett ML. Facial Paralysis in Skull Base Osteomyelitis - Comparison of Surgical and Nonsurgical Management. Laryngoscope 2023; 133:179-183. [PMID: 35546515 DOI: 10.1002/lary.30161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 02/02/2023]
Abstract
TITLE Facial Paralysis in Skull Base Osteomyelitis - Comparison of Surgical and Nonsurgical Management. OBJECTIVE To compare outcomes of surgical and nonsurgical management in cases of facial paresis secondary to skull base osteomyelitis. METHODS A 14 patients presenting with skull base osteomyelitis complicated by facial nerve paresis at a single tertiary referral center from 2009 to 2019 were retrospectively reviewed. Patients were treated with medical therapy with or without surgical intervention, consisting of mastoidectomy and debridement with or without facial nerve decompression. House-Brackmann (HB) Grade was the main outcome measure. RESULTS A 14 patients (average age 68 years, range 58-82 years, 71% male) were analyzed, with 5 undergoing facial nerve decompression (36%), 5 undergoing mastoidectomy without facial nerve decompression (36%), and 4 undergoing medical management alone (28%). Of the 4 patients who underwent medical therapy alone, none experienced significant improvement in facial function. Of the 5 patients who underwent facial nerve decompression, 3 patients experienced improved facial function. Of the 5 patients who underwent mastoidectomy without decompression, 4 experienced improved facial function. There was no clear link between the severity of infection and the severity of facial paresis. When comparing HB score changes before and after treatment across groups, there was no statistically significant difference seen (p = 0.47). CONCLUSIONS Mastoidectomy and debridement with or without facial nerve decompression may improve facial nerve outcomes when compared to isolated medical management, although differences were not of statistical significance. The best facial nerve recoveries occurred in patients undergoing surgery within 14 days of the onset of paralysis. LEVEL OF EVIDENCE 4 - Case Series Laryngoscope, 133:179-183, 2023.
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Affiliation(s)
- Michael H Freeman
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth L Perkins
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kareem O Tawfik
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew R O'Malley
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert F Labadie
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David S Haynes
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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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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Takahashi K, Morita Y, Ogi M, Nonomura Y, Kitazawa M, Yagi C, Yamagishi T, Ohshima S, Izumi S, Horii A. Optimal Diagnostic Criteria and a Staging System for Otogenic Skull Base Osteomyelitis. J Neurol Surg B Skull Base 2022; 83:e484-e491. [PMID: 35832975 PMCID: PMC9272291 DOI: 10.1055/s-0041-1732308] [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: 03/16/2021] [Accepted: 06/08/2021] [Indexed: 10/17/2022] Open
Abstract
Objective Diagnostic criteria for otogenic skull base osteomyelitis (SBO) have been conflicting among researchers. We aimed to propose clinically useful diagnostic criteria and a staging system for otogenic SBO that is associated with infection control and mortality. Design The present study is designed as a retrospective one. Setting This study was conducted at the University Hospital. Participants Thirteen patients with otogenic SBO who met the novel rigorous diagnostic criteria consisted of symptomatic and radiological signs on high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI). Simple refractory external otitis was not included. A staging system according to disease extent revealed by HRCT and MRI is proposed: lesions limited to the temporal bone (stage 1), extending to less than half (stage 2), exceeding the midline (stage 3), and extending to the whole of the clivus (stage 4). All patients received long-term antibiotic therapy. Patients were divided into infection-uncontrolled or -controlled groups based on symptoms, otoscopic findings, and C-reactive protein level at the last follow-up. The mean follow-up period was 27.7 months. Main Outcome Measures Possible prognostic factors, such as immunocompromised status and symptoms, including cranial nerve palsy, pretreatment laboratory data, and treatments, were compared between the infection-uncontrolled and -controlled groups. Disease stages were correlated with infection control and mortality. Results The infection-uncontrolled rate and mortality rate were 38.5 and 23.1%, respectively. There were no significant differences in possible prognostic factors between the infection-uncontrolled and -controlled groups. HRCT-based stages significantly correlated with infection control and mortality. Conclusion We proposed here the clinically useful diagnostic criteria and staging systems that can predict infection control and prognosis of otogenic SBO.
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Affiliation(s)
- Kuniyuki Takahashi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuka Morita
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Manabu Ogi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoriko Nonomura
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Meiko Kitazawa
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Chihiro Yagi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuya Yamagishi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shinsuke Ohshima
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shuji Izumi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Arata Horii
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Respond to letter of Jerzy Kuczkowski. Eur Arch Otorhinolaryngol 2022; 279:3221-3222. [DOI: 10.1007/s00405-022-07398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
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Margulis I, Cohen-Kerem R, Roitman A, Gez-Reder H, Aviram A, Bitterman-Fisher S, Kugelman N, Doweck I. Laboratory and imaging findings of necrotizing otitis externa are associated with pathogen type and disease outcome: A retrospective analysis. EAR, NOSE & THROAT JOURNAL 2022:1455613221080973. [PMID: 35311376 DOI: 10.1177/01455613221080973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine associations of laboratory and imaging data with diagnostic parameters of necrotizing otitis externa (NOE) and its severity, and to compare between bacterial and fungal infections. METHODS Records of patients diagnosed with NOE during 2010-2018 at the Department of Otolaryngology, Head and Neck Surgery were reviewed retrospectively for demographics; disease characteristics; and laboratory, scintigraphy, and imaging results. RESULTS Of 48 patients with NOE, the mean age is 73±11.6 years; 32 (67%) were males; 83% had diabetes mellitus. Common pathogens were pseudomonas (49%) and fungi (33%). Sensitivities of the technetium-scan (SPECT ratio ≥1.5), temporal bone computed tomography (CT), and gallium-scan (SPECT ratio ≥1.3) were: 78.7%, 48.8%, and 31.4%, respectively. Gallium-scan results correlated positively with CT bone involvement (p=0.002) and hospital length of stay (p=0.0014). C-reactive protein (CRP) level correlated with hospital length of stay (p=0.028) and positive technetium-scan results (p=0.012). Fungal infection had a higher technetium SPECT ratio (2.16 vs. 1.77, p=0.04), gallium SPECT ratio (1.4 vs. 1.2, p=0.02), longer duration of systemic treatment (87.4 vs. 37.9 days, p=0.014), and longer hospital length of stay (31.6 vs. 15.2 days, p=0.004) compared to non-fungal infection. Eight (17%) patients had responded poorly to treatment. Fungal pathogens, facial nerve paresis, extra-auricular, and bilateral disease were more prevalent among the non-responders. CONCLUSION The technetium scan has higher sensitivity than temporal bone CT for diagnosing NOE. The gallium scan and CRP correlated well with hospital length of stay. A high rate of fungal infection was found, with significantly higher technetium and gallium SPECT ratios and worse outcome compared to bacterial infection. Fungal NOE remains therapeutically challenging.
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Affiliation(s)
- Itai Margulis
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Raanan Cohen-Kerem
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ariel Roitman
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Hadar Gez-Reder
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ariel Aviram
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Sivan Bitterman-Fisher
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Nir Kugelman
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ilana Doweck
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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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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Koshiba Y, Ikeda R, Suzuki J, Honkura Y, Funayama Y, Ikeda K, Warita H, Aoki M, Kawase T, Katori Y. Malignant otitis externa presenting cerebral infarction from pseudoaneurysm: A case report and a review of the literature. Clin Case Rep 2022; 10:e05276. [PMID: 35223001 PMCID: PMC8843815 DOI: 10.1002/ccr3.5276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/24/2021] [Accepted: 12/29/2021] [Indexed: 11/24/2022] Open
Abstract
Chronic renal failure and diabetes mellitus could also be risk factors of pseudoaneurysm of the internal carotid artery (ICA) due to malignant otitis externa (MOE). Although pseudoaneurysm of the ICA is a rarely encountered disease, it should always be taken into consideration when treating patients of MOE.
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Affiliation(s)
- Yasutoshi Koshiba
- Department of Otolaryngology, Head and Neck SurgeryTohoku University School of MedicineSendaiJapan
| | - Ryoukichi Ikeda
- Department of Otolaryngology, Head and Neck SurgeryTohoku University School of MedicineSendaiJapan
| | - Jun Suzuki
- Department of Otolaryngology, Head and Neck SurgeryTohoku University School of MedicineSendaiJapan
| | - Yohei Honkura
- Department of Otolaryngology, Head and Neck SurgeryTohoku University School of MedicineSendaiJapan
| | - Yukino Funayama
- Department of NeurologyTohoku University School of MedicineSendaiJapan
| | - Kensuke Ikeda
- Department of NeurologyTohoku University School of MedicineSendaiJapan
| | - Hitoshi Warita
- Department of NeurologyTohoku University School of MedicineSendaiJapan
| | - Masashi Aoki
- Department of NeurologyTohoku University School of MedicineSendaiJapan
| | - Tetsuaki Kawase
- Department of Otolaryngology, Head and Neck SurgeryTohoku University School of MedicineSendaiJapan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck SurgeryTohoku University School of MedicineSendaiJapan
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Kim DH, Kim SW, Hwang SH. Predictive value of radiologic studies for malignant otitis externa: a systematic review and meta-analysis. Braz J Otorhinolaryngol 2021; 89:66-72. [PMID: 34799270 PMCID: PMC9874358 DOI: 10.1016/j.bjorl.2021.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/06/2021] [Accepted: 08/31/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To determine the diagnostic accuracy of Necrotizing Otitis Externa (NOE) based on radiologic studies. METHODS The PubMed, Cochrane, Embase, Web of Science, SCOPUS, and Google Scholar databases were searched. True-positive and false-negative results were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. RESULTS The included studies contained data on 37 studies diagnosed with NOE. The sensitivity of gallium-67, technetium-99m, and Magnetic Resonance Imaging (MRI) was 0.9378 (0.7688-0.9856), 0.9699 (0.8839-0.9927), and 0.9417 (0.6968-0.9913), respectively. For Computed Tomography (CT), the positive criteria consisted of bony erosion alone and bony erosion plus any soft tissue abnormality. The sensitivity of CT based only on bony erosion was 0.7062 (0.5954-0.7971); it was higher 0.9572 (0.9000-0.9823) when based on bony erosion plus any soft tissue abnormality. CONCLUSION The diagnostic sensitivity of technetium-99m, gallium-67, and MRI was favorable. On CT, the presence of bony erosion may be a useful diagnostic marker of NOE, but the diagnostic sensitivity will be even higher if the criterion of any soft tissue abnormality is also included; however, care should be taken when interpreting the results. Our study demonstrates the potential utility of radiology studies for diagnosing NOE, but their lack of specificity must be considered, and standardized anatomic criteria are still needed. LEVEL OF EVIDENCE 2A.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea,Corresponding author.
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Emerging themes in necrotising otitis externa: a scoping review of the literature 2011-2020 and recommendations for future research. The Journal of Laryngology & Otology 2021; 136:575-581. [PMID: 34666847 DOI: 10.1017/s0022215121003030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
PURPOSE OF REVIEW Skull base osteomyelitis (SBO) is a life-threatening condition. Due to an aging and increasingly multimorbid population, clinicians are more often challenged with this disease. Yet, there is no consensus on the optimal diagnostic and follow-up management. This review should aid clinicians in decision-making for their patients. RECENT FINDINGS Treatment-resistant otalgia or headache is suspicious of SBO. Pseudomonas aeruginosa remains the most common pathogen but clinicians are challenged with increasing rates of sterile or fungal cultures due to previously applied antibiotics/steroids. No single imaging modality is able to detect the full extent of the disease. Whereas functional nuclear imaging with gallium-67 or methylene diphosphonate-technetium-99m was once advocated, its actual benefit is questionable. Newer modalities such as fluoro-D-glucose-positron emission tomography (PET)/computed tomography, PET/magnetic resonance imaging (MRI), or diffusion-weighted MRI seem to be promising in diagnosis and follow-up. Finding the causative pathogen is of utmost importance followed by long-term intravenous antibiotics until the disease has completely resolved. Surgery plays a minor role in treatment but can be helpful in selected cases. SUMMARY The numerous challenges in SBO render management difficult, but with a clear work-up including regular clinical, laboratory and imaging examinations, outcome can be improved.
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Affiliation(s)
- Alice B Auinger
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
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20
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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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Abstract
Otalgia, otorrhea and hearing loss are the most common ear-related symptoms that lead to the consultation of an otolaryngologist. Furthermore, balance disorders and affections of the cranial nerve function may play a role in the consultation. In large academic centres, but also in primary care, the identification of rare diseases of the middle ear and the lateral skull base is essential, as these diseases often require interdisciplinary approaches to establish the correct diagnosis and to initiate safe and adequate treatments. This review provides an overview of rare bone, neoplastic, haematological, autoimmunological and infectious disorders as well as malformations that may manifest in the middle ear and the lateral skull base. Knowledge of rare disorders is an essential factor ensuring the quality of patient care, in particular surgical procedures. Notably, in untypical, complicated, and prolonged disease courses, rare differential diagnoses need to be considered.
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Affiliation(s)
- Nora M. Weiss
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie
„Otto Körner“ der Universitätsmedizin Rostock,
Deutschland
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Treviño González JL, Reyes Suárez LL, Hernández de León JE. Malignant otitis externa: An updated review. Am J Otolaryngol 2021; 42:102894. [PMID: 33429178 DOI: 10.1016/j.amjoto.2020.102894] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/27/2020] [Indexed: 11/18/2022]
Abstract
Malignant otitis externa is a progressive infection of the external auditory canal and skull base. Pseudomonas aeruginosa is the most isolated microorganism and it affects mostly to diabetic, elderly, and immunocompromised individuals. Non-resolving otalgia and chronic otorrhea are the clinical manifestations presented. Facial nerve palsy is a common and well recognized complication. (Computed tomography) CT scan is useful for initial assessment, Technetium-99m is highly sensitive and is part of the protocol for diagnosis. Treatment should be individualized, with multidisciplinary cooperation among specialties. Management involves systemic antipseudomonal antibiotics and monitoring with radiologic techniques, it also involves the strict control of diabetes. It is essential to follow up the patients for at least a year post-treatment. In refractory malignant otitis externa and affection of facial nerve, surgical management is recommended. We reviewed the most recent studies on epidemiology, clinical manifestations, diagnosis, and treatment to provide an update on Malignant Otitis Externa that can offer an overview for clinical practice and future research.
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Computer tomography findings in necrotizing otitis externa based on the offending pathogens. Eur Arch Otorhinolaryngol 2021; 278:4707-4713. [PMID: 33502545 DOI: 10.1007/s00405-020-06583-7] [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: 07/29/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE High-resolution temporal bone computer tomography (HRTBCT) is the most common initial radiological modality used for the assessment of necrotizing otitis externa (NOE). OBJECTIVES (1) To compare the extension of disease, as seen on HRTBCT, in patients with NOE caused by different pathogens and (2) assess whether radiological findings may suggest the offending pathogen in cases of sterile-NOE. METHODS All NOE patients were hospitalized between 1990 and 2018. All patients underwent HRTBCT at admission. Three groups (fungus-NOE, PA-NOE and sterile-NOE) comprising of ten patients each were randomly selected. HRTBCT was reevaluated by a senior radiologist. Thirteen radiological subsites were selected for reevaluation. RESULTS All patients in the fungal-NOE group complained of otalgia, compared to nine in the sterile-NOE and six in the PA-NOE groups (p value = 0.044). External ear canal edema and granulation tissue were the most common findings in all groups. Surgery was performed in five patients in the fungal-NOE and PA-NOE and three in the sterile-NOE group (p value = > 0.05). Radiological findings indicating severe bone erosion within the EEC was seen in all patients but 3 (p value = > 0.05). Severe TMJ erosion was seen in one patient within the fungal-NOE and PA-NOE group (p value = > 0.05). When mild and severe involvement were combined, TMJ bone erosion was seen in four patients in the fungal-NOE and only in one patient in the PA-NOE (p = 0.04). CONCLUSIONS TMJ involvement may be more common in fungal disease, suggesting a different spreading pathway, as opposed to PA-NOE. Accordingly, TMJ involvement on HRTBCT may justify antifungal treatment in sterile culture-NOE.
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Hasnaoui M, Ben Mabrouk A, Chelli J, Larbi Ammari F, Lahmar R, Toumi A, Mighri K. Necrotising otitis externa: A single centre experience. J Otol 2020; 16:22-26. [PMID: 33505446 PMCID: PMC7814081 DOI: 10.1016/j.joto.2020.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/10/2020] [Accepted: 07/22/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Necrotising otitis externa (NOE) is a rare infection of the ear canal with frequent bone erosion. This study’s objective is to describe the different features of NOE as well as its management in an ear-nose-throat department. We also tried to identify the particularities of the fungal infection. Patients and methods It is an observational cohort that included all the patients hospitalised for the management of NOE. The study was carried out in the ear-nose-throat Department of Mahdia University Hospital in Tunisia between January 2006 and december 2019. Results A total of 40 patients were included. The mean age was 65 ± 12.9 years and the sex ratio was 0.9. Ninety percent of the patients included were diabetics. The most common signs found were oedema of the external canal (97.5%) and auricular discharge (92.5%). The main pathogen isolated was Pseudomonas aeruginosa (61.7%). Fungi were isolated in 9 cases (26.47%). Computed tomography was performed for 32 patients (80%). Bone erosion was seen in 26 cases (81.3%). The main complications were cerebral venous thrombosis, retropharyngeal abscess and cerebral empyema. Thirty one patients received only antibiotics, 2 received only antifungal treatment, and 7 received both antibiotics and antifungal treatment. All patients had a favorable outcome. Univariate analysis showed a higher median erythrocyte sedimentation rate was associated with fungal infections. No other differences were noted. Conclusion Our management protocol seems to be efficient since all patients had initial favorable outcome. A higher median erythrocyte sedimentation rate was associated with fungal infections. Necrotising otitis externa has a variable clinical presentation and a relatively high rate of complications. The patients were mainly diabetics or aged more than 65 years old. The main pathogen isolated was Pseudomonas aeruginosa. A higher median erythrocyte sedimentation rate was associated with fungal infections.
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Affiliation(s)
- Mehdi Hasnaoui
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, 5100, Tunisia
| | - Asma Ben Mabrouk
- Department of Infectious Diseases, Fattouma Bourguiba Hospital, Monastir, 5000, Tunisia
| | - Jihene Chelli
- Department of Endocrinology and Internal Medicine, Tahar Sfar Hospital, Mahdia, 5100, Tunisia
| | - Fatma Larbi Ammari
- Department of Endocrinology and Internal Medicine, Tahar Sfar Hospital, Mahdia, 5100, Tunisia
| | - Rihab Lahmar
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, 5100, Tunisia
| | - Adnene Toumi
- Department of Infectious Diseases, Fattouma Bourguiba Hospital, Monastir, 5000, Tunisia
| | - Khalifa Mighri
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, 5100, Tunisia
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Prediction of skull base osteomyelitis in necrotising otitis externa with diffusion-weighted imaging. The Journal of Laryngology & Otology 2020; 134:404-408. [PMID: 32498734 DOI: 10.1017/s0022215120001073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To predict skull base osteomyelitis in patients with necrotising otitis externa using diffusion-weighted imaging. METHODS A retrospective analysis was conducted of 25 necrotising otitis externa patients with skull base osteomyelitis (n = 10) or without skull base involvement (n = 14) who underwent a single-shot diffusion-weighted imaging of the skull base. RESULTS The respective mean apparent diffusion coefficient values of the skull base, as determined by two reviewers, were 0.851 ± 0.15 and 0.841 ± 0.14 ×10-3mm2/s for the skull base osteomyelitis patients, and 1.065 ± 0.19 and 1.045 ± 0.20 ×10-3mm2/s for the necrotising otitis externa patients without skull base involvement. The difference in apparent diffusion coefficients between the groups was significant, for both reviewers (p = 0.008 and 0.012). The optimal threshold apparent diffusion coefficient for predicting skull base osteomyelitis in necrotising otitis externa patients was 0.945 ×10-3mm2/s and 0.915 ×10-3mm2/s, with an area under the curve of 0.825 and 0.800, accuracy of 87.5 and 83.3 per cent, sensitivity of 85.7 and 90.0 per cent, and specificity of 90.0 and 78.6 per cent, for each reviewer respectively. CONCLUSION Apparent diffusion coefficient is a non-invasive imaging parameter useful for predicting skull base osteomyelitis in necrotising otitis externa patients.
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Affiliation(s)
- Nevio Cimolai
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada, Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
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Peled C, Parra A, El-saied S, Kraus M, Kaplan DM. Surgery for necrotizing otitis externa—indications and surgical findings. Eur Arch Otorhinolaryngol 2020; 277:1327-1334. [DOI: 10.1007/s00405-020-05842-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
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Schwam ZG, Ferrandino R, Kaul VZ, Wanna GB, Cosetti MK. Thirty-Day Readmission and Prolonged Length of Stay in Malignant Otitis Externa. Laryngoscope 2019; 130:2220-2228. [PMID: 31758583 DOI: 10.1002/lary.28409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/15/2019] [Accepted: 10/23/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To determine independent risk factors for 30-day readmission, prolonged length of stay (PLOS), and discharge to a rehabilitation facility for those with malignant otitis externa. METHODS Retrospective cohort study of patients hospitalized with malignant otitis externa (International Classification of Diseases, 9th edition, code 380.14) in the Nationwide Readmissions Database (2013-2014). Overall and disease-specific complication and mortality data were analyzed using chi-squared and multivariate analysis. RESULTS There were 1267 cases of malignant otitis externa extracted. A PLOS of ≥8 days (90th percentile) was found in 14.2% (n = 180) of patients, and 13.7% (n = 174) were discharged to a facility. Patients were readmitted within 30 days at a rate of 12.5% (n = 159). The overall rates of uncomplicated and complicated diabetes were found to be 42.1% and 17.8%, respectively. Factors independently associated with PLOS included undergoing a surgical procedure (odds ratio [OR] 2.08, P < .001), and having central nervous system complications (OR 3.21, P < .001). Independent risk factors for disposition to a facility included nutritional deficiency (OR 1.91, P = .029), PLOS (OR 4.61, P < .001), and age 65-79 years (OR 6.57, P = .001). Readmission was independently linked to PLOS (OR 3.14, P < .001). Diabetes was not an independent risk factor for any outcome. CONCLUSIONS Thirty-day readmission, PLOS, and ultimate discharge to a rehabilitation facility were common and closely intertwined. Despite the classic association between diabetes and malignant otitis externa, diabetes was not an independent risk factor for any of our outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2220-2228, 2020.
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Affiliation(s)
- Zachary G Schwam
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, U.S.A
| | - Rocco Ferrandino
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, U.S.A
| | - Vivian Z Kaul
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, U.S.A
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, U.S.A.,Audiology, Hearing, and Balance Center, Mount Sinai Health System, New York, New York, U.S.A.,Ear Institute, Mount Sinai Health System, New York, New York, U.S.A
| | - Maura K Cosetti
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, U.S.A.,Audiology, Hearing, and Balance Center, Mount Sinai Health System, New York, New York, U.S.A.,Ear Institute, Mount Sinai Health System, New York, New York, U.S.A
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Moss WJ, Finegersh A, Narayanan A, Chan JYK. Meta‐analysis does not support routine traditional nuclear medicine studies for malignant otitis. Laryngoscope 2019; 130:1812-1816. [DOI: 10.1002/lary.28411] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/29/2019] [Accepted: 10/18/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Wiliam James Moss
- Division of Otolaryngology‐Head & Neck Surgery, Department of SurgeryCommonwealth Health Center Saipan CNMI
| | - Andrey Finegersh
- Division of Otolaryngology–Head & Neck Surgery, Department of SurgeryUniversity of California, San Diego San Diego California U.S.A
| | - Ajay Narayanan
- Department of Otolaryngology–Head & Neck SurgeryUniversity of Texas Southwestern Dallas Texas U.S.A
| | - Jason Ying Kuen Chan
- Department of Otolaryngology–Head & Neck SurgeryThe Chinese University of Hong Kong Shatin HK
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Abstract
Thromboses in the head and neck region are rare events, particularly in the internal jugular vein. However, they can result in potentially hazardous complications. Possible triggers are inflammatory, traumatic, and (para-)neoplastic diseases. Clinical symptoms often are non-specific, and it is thus important to even consider the possibility of an internal jugular vein thrombosis. Sonography is the diagnostic tool of choice, which can be complemented by CT/MRI if necessary. Depending on the individual etiology, antithrombotic treatment including modern direct oral anticoagulants (DOAC) is advisable. In cases of sepsis, surgery is mandatory to control the focus. However, there is hardly any evidence concerning this unusual problem due to the low incidence.
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