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Byun YJ, Patel J, Nguyen SA, Lambert PR. Hyperbaric oxygen therapy in malignant otitis externa: A systematic review of the literature. World J Otorhinolaryngol Head Neck Surg 2021; 7:296-302. [PMID: 34632343 PMCID: PMC8486695 DOI: 10.1016/j.wjorl.2020.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 03/09/2020] [Accepted: 04/13/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To review the role of adjuvant hyperbaric oxygen therapy (HBOT) in the treatment of malignant otitis externa (MOE). DATA SOURCES PubMed, Scopus, Web of Science, Science Direct, and Cochrane Library were searched for the following concepts: "hyperbaric oxygen" and "malignant or necrotizing otitis externa." METHODS Studies were included if they contained (1) patients with reported evidence of MOE, (2) employment of adjuvant HBOT, (3) details on patients' medical condition, and (4) documented survival outcomes. Extracted information included patient demographics, underlying medical conditions, infectious etiology, signs and symptoms, medical and surgical treatments, duration of medical treatment, mean follow up time, HBOT setting, number of HBOT sessions, complications, survival rate, and all-cause mortality. RESULTS A total of 16 studies comprising 58 patients (mean age 68.0 years) were included. Diabetes was present in 94.7% of cases and Pseudomonas spp (64.3%) was the most common infectious agent. Cranial nerve VII was involved in 55.2% of cases. Overall, the disease cure rate with adjuvant HBOT was 91.4% and all-cause mortality was 8.6%. Among those who had cranial nerve VII involvement, 72.0% had return of function and 93.8% of them survived. CONCLUSION HBOT may be an effective treatment option for refractory or advanced MOE but its efficacy remains unproven due to lack of strong scientific evidence. However, its therapeutic value should not be underestimated given good results and few adverse events reported in this study.
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Affiliation(s)
- Young Jae Byun
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Jaimin Patel
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A. Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Paul R. Lambert
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Koleri J, Al Bishawi A, Al-Sheikh I, Qureshi S, AlMaslamani M, Abdelhadi H. Beware of covert enemies: Candida orthopsilosis malignant otitis externa with base of the skull osteomyelitis, a case report and review of literature. IDCases 2021; 25:e01163. [PMID: 34094863 PMCID: PMC8164024 DOI: 10.1016/j.idcr.2021.e01163] [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: 02/06/2021] [Revised: 04/25/2021] [Accepted: 05/16/2021] [Indexed: 11/27/2022] Open
Abstract
Background Malignant otitis externa (MOE) is a serious infection of the external auditory canal that is frequently associated with skull base osteomyelitis (SBO) as well as secondary neurological sequelae. Patients with poorly controlled diabetes mellitus or immunosuppression are at increased risk of developing such critical infection for multiple local and systemic factors. While most cases are secondary to bacterial infections particularlyPseudomonas aeruginosa, fungal infections are also occasionally encountered, often associated with delayed diagnosis and high morbidity and mortality. Case report We report a case of a 63 years old man with uncontrolled diabetes mellitus who presented with symptoms and signs of MOE, supported by radiological assessments. The patient was treated presumptively with a prolonged course of antibiotics without clinical improvement, coupled with progression of radiological findings and significant disease extension. Reassessment with biopsies and tissue cultures from external auditory meatus, tempo-mandibular bone, as well as base of the skull grew Candida orthopsilosis. The patient received induction treatment with high dose liposomal amphotericin followed by fluconazole to control disease progression and complications. Conclusion Candida MOE with secondary skull base osteomyelitis is rare and difficult to diagnose with no clear guidance on assessment and management. Clinicians should be aware of the unusual presentations where microbiological and histopathological evaluations are essential for proper management.
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Affiliation(s)
- Junais Koleri
- Department of Infectious Diseases, Communicable Diseases Centre, Hamad Medical Corporation, Qatar
| | - Ahmad Al Bishawi
- Department of Infectious Diseases, Communicable Diseases Centre, Hamad Medical Corporation, Qatar
| | - Israa' Al-Sheikh
- Department of Internal Medicine, Hamad Medical Corporation, Qatar
| | - Salman Qureshi
- Department of Neuroradiology, Hamad Medical Corporation, Qatar
| | - Muna AlMaslamani
- Department of Infectious Diseases, Communicable Diseases Centre, Hamad Medical Corporation, Qatar
| | - Hamad Abdelhadi
- Department of Infectious Diseases, Communicable Diseases Centre, Hamad Medical Corporation, Qatar
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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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Isaacson G. Oxymetazoline, Mupirocin, Clotrimazole-Safe, Effective, Off-Label Agents for Tympanostomy Tube Care. EAR, NOSE & THROAT JOURNAL 2020; 99:30S-34S. [PMID: 32182136 DOI: 10.1177/0145561320912885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Only a few medications have a United States Food and Drug Administration indications for prevention and/or treatment of infections in patients with tympanic perforations or tympanostomy tubes. We examined 3 off-label agents that have become important in tympanostomy tube care hoping to demonstrate the effectiveness and safety of each in experimental assays and human application. METHODS Computerized literature review. RESULTS (1) Oxymetazoline nasal spray applied at the time of surgery is equivalent to fluoroquinolone ear drops in the prevention of early postsurgical otorrhea and tympanostomy tube occlusion at the first postoperative visit. (2) Topical mupirocin 2% ointment is effective alone or in combination with culture-directed systemic therapy for the treatment of tympanostomy tube otorrhea caused by community-acquired, methicillin-resistant Staphylococcus aureus. (3) Topical clotrimazole 1% cream is highly active against the common yeast and fungi that cause otomycosis. A single application after microscopic debridement will cure fungal tympanostomy tube otorrhea in most cases. None of these 3 agents is ototoxic in animal histological or physiological studies, and each has proved safe in long-term clinical use. CONCLUSIONS Oxymetazoline nasal spray, mupirocin ointment, and clotrimazole cream are safe and effective as off-label medications for tympanostomy tube care in children.
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Affiliation(s)
- Glenn Isaacson
- Department of Otolaryngology-Head & Neck Surgery, 12314Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.,Department of Pediatrics, 12314Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
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Malignant (necrotizing) externa otitis: the experience of a single hyperbaric centre. Eur Arch Otorhinolaryngol 2019; 276:1881-1887. [PMID: 31165255 DOI: 10.1007/s00405-019-05396-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/08/2018] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Malignant otitis externa (MOE) is a potentially life-threatening infection of the soft tissues of the external ear, quickly spreading to involve the periosteum and bone of the skull base. Treatment includes antibiotics and eventually surgery. Hyperbaric oxygen treatment (HBOT) has been proposed as an adjunctive therapy. However, in the tenth consensus conference, this disease was considered as a non-indication for HBOT. The aim of this study was to evaluate the effectiveness of HBOT in MOE treatment. METHODS Retrospective and observational study was conducted of patients with MOE treated in our centre. Staging of the disease was made according to the clinicopathological classification system. RESULTS From March 1998 to November 2016, 16 patients were referred. 6% patients were on stage 1 of the disease at the time they were referred, 20% in stage 2, 7% in stage 3a, 13% in stage 3b and 53% in stage 4. Seven (43.75%) patients had VII nerve palsy and three (18.75%) patients had multiple nerve palsy. Average length of symptoms of disease was 5 months (maximum 11 months). Average number of sessions was 33 and the length of hospitalization prior to HBOT (median 90 days) was significantly longer than the time between beginning HBOT and cure (p = 0.028, Wilcoxon signed rank test). There were no fatalities due to MOE and all patients were considered free of disease after HBOT. CONCLUSION HBOT was well tolerated and revealed to be a helpful adjuvant treatment in MOE. According to our data, HBOT should be considered for patients who failed conventional treatments and in severe cases.
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Chaudhary HA, Ibrahim WH, Yousaf Z, Abubeker IY, Kartha A. Fungal Malignant Otitis Externa Involves a Cascade of Complications Culminating in Pseudoaneurysm of Internal Maxillary Artery: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:562-566. [PMID: 31005959 PMCID: PMC6489412 DOI: 10.12659/ajcr.913469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Male, 66 Final Diagnosis: Pseudoaneurysm of internal maxillary artery secondary to fungal malignant otitis externa Symptoms: Epistaxis Medication: — Clinical Procedure: Functional endoscopic sinus surgery, endovascular embolization Specialty: Infectious Diseases
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Affiliation(s)
| | - Wanis H Ibrahim
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zohaib Yousaf
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Anand Kartha
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Idiopathic, Infectious and Reactive Lesions of the Ear and Temporal Bone. Head Neck Pathol 2018; 12:328-349. [PMID: 30069844 PMCID: PMC6081288 DOI: 10.1007/s12105-018-0952-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/13/2018] [Indexed: 12/13/2022]
Abstract
A number of infectious, inflammatory and idiopathic lesions develop within otologic tissues that may share similar clinical and/or microscopic features. This review first provides a working classification for otitis externa, and then otitis media and includes two recently described entities, eosinophilic otitis media and otitis media with ANCA-associated vasculitis. Next, the microscopic findings of a spectrum of otopathologic conditions are described, including post-inflammatory conditions such as tympanosclerosis and aural polyps, an overview of animate aural foreign body as well as iatrogenic aural foreign body reactions. Finally, a review of fungal disease affecting the ear with a brief synopsis of Candida auris, a recently described and virulent organism, is presented.
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Hasibi M, Ashtiani MK, Motassadi Zarandi M, Yazdani N, Borghei P, Kuhi A, Dabiri S, Hosseini R, Sardashti S. A Treatment Protocol for Management of Bacterial and Fungal Malignant External Otitis: A Large Cohort in Tehran, Iran. Ann Otol Rhinol Laryngol 2017; 126:561-567. [PMID: 28528568 DOI: 10.1177/0003489417710473] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIMS High rates of negative microbiologic test results highlight the potential role of empiric antimicrobial agents in management of malignant otitis externa (MOE). This study investigates the clinical presentation, laboratory findings, and response to empiric treatment in a large group of patients admitted to a tertiary academic hospital in Tehran, Iran. METHODS AND MATERIALS We recruited 224 patients diagnosed with MOE in a prospective observation from 2009 through 2015. All patients received a 2-agent antibacterial regimen at baseline (phase I). Patients with no improvement within 10 days and/or nonresponders to a second course of antibacterials were switched to antifungals (phase II). Response to treatment was observed and documented in both groups. RESULTS All patients had physical symptoms for more than 12 weeks before admission. In total, 127 patients responded well to antibacterials. Eighty-seven out of 97 patients who were switched to antifungals had complete response to treatment; patients in the latter group had significantly higher A1C levels at baseline. CONCLUSION Our findings provide evidence to develop clinical guidelines that accelerate diagnosis and treatment of MOE to improve patient outcomes.
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Affiliation(s)
| | | | | | - Nasrin Yazdani
- 2 Tehran University of Medical Sciences Department and Research Center of Otolaryngology Head and Neck Surgery, Tehran, Iran, Islamic Republic Of
| | | | - Ali Kuhi
- 1 Amir-Alam Hospital, Tehran, Iran, Islamic Republic Of
| | - Sasan Dabiri
- 1 Amir-Alam Hospital, Tehran, Iran, Islamic Republic Of
| | - Reza Hosseini
- 3 Imam Khomeini Hospital, Tehran, Iran, Islamic Republic Of
| | - Sara Sardashti
- 4 Iranian Research Center for HIV/AIDS, Tehran, Iran, Islamic Republic Of
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