Necrotizing Otitis Externa: A Disease Barely Known to Neurosurgeons

AbstractNecrotizing otitis externa (NOE), also known as malignant otitis externa (MOE), is a severe and rare infectious disease of the external auditory canal (EAC). Without treatment, it may progress to skull base involvement. The bacteria Pseudomonas aeruginosa is the most common causative agent (∼ 90% of the cases), and affects immunocompromised subjects, particularly diabetic patients. Severe chronic otalgia, otorrhea, and cranial nerve palsy are the most common clinical presentations. Patients with NOE are frequently referred to neurosurgery because of the neurological impairment and skull base compromise. The definitive diagnosis is frequently elusive, requiring a high index of suspicion. Several laboratorial tests, imaging modalities, and the histologic exclusion of malignancy may be required. An early diagnosis and aggressive treatment reduce morbidity and mortality. We present four NOE cases to illustrate the spectrum of clinical presentation and complementary exams. According to the literature, more effort for early diagnosis and treatment is required, and neurosurgeons play an important role in this task.

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651. Comparative Analysis Between Bacterial And Fungal Malignant Otitis Externa

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.845 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S383-S384

Author(s):

Fatma Hammami ◽

Makram Koubaa ◽

Amal Chakroun ◽

Fatma Smaoui ◽

Khaoula Rekik ◽

...

Keyword(s):

Otitis Externa ◽

Clinical Presentation ◽

The Elderly ◽

Causative Organism ◽

Diabetic Patients ◽

Duration Of Treatment ◽

Evolutionary Features ◽

Significant Difference ◽

Malignant Otitis Externa ◽

History Of

Abstract Background Malignant otitis externa is a fatal infection of the external ear and temporal bone. Pseudomonas aeruginosa is the most common causative organism, while fungi are a rare cause of malignant otitis externa. We aimed to compare the clinical, therapeutic and evolutionary features between bacterial and fungal malignant otitis externa. Methods We conducted a retrospective study including all patients hospitalized for malignant otitis externa in the infectious diseases department between 2000 and 2018. Results Overall, we encountered 82 cases of malignant otitis externa, among which there were 54 cases (65.9%) of bacterial malignant otitis externa (BMO) and 28 cases (34.1%) of fungal malignant otitis externa (FMO). The males were predominant among BMO cases (57.4% vs 50%; p=0.5). Patients with FMO were significantly older (70±9 years vs 61±10 years; p< 0.001) and had medical history of diabetes mellitus more frequently (96.4% vs 77.8%; p=0.03). The use of topical corticosteroids was significantly more reported among FMO cases (28.6% vs 5.6%; p=0.006). Otalgia (96.4% vs 81.5%), otorrhea (75% vs 66.7%) and cephalalgia (46.4% vs 42.6%) were the revealing symptoms among FMO and BMO, respectively, with no significant difference. Tenderness to palpation of the mastoid bone (64.3% vs 38.9%; p=0.02) and stenosis of the external auditory canal (92.9% vs 72.2%; p=0.02) were significantly more frequent among FMO cases. Complications were significantly more frequent among FMO cases (42.9% vs 9.3%; p< 0.001). Treatment duration was significantly longer among FMO cases (70[40-90] days vs 45[34-75] days; p=0.03). Conclusion Our study showed that FMO affected more frequently the elderly and diabetic patients, when compared with BMO. Regardless of the causative agent, the clinical presentation was similar. However, the outcome was poor among FMO cases with the occurrence of complications, requiring a longer duration of treatment. Disclosures All Authors: No reported disclosures

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Atypical presentations of malignant otitis externa

The Journal of Laryngology & Otology ◽

10.1017/s0022215110000307 ◽

2010 ◽

Vol 124 (11) ◽

pp. 1205-1208 ◽

Cited By ~ 7

Author(s):

Z Vourexakis ◽

M-I Kos ◽

J-P Guyot

Keyword(s):

Pseudomonas Aeruginosa ◽

Skull Base ◽

Diagnostic Criteria ◽

Otitis Externa ◽

Case Reports ◽

Clinical Manifestations ◽

Diabetic Patients ◽

Malignant Otitis Externa ◽

Life Threatening ◽

Atypical Presentations

AbstractIntroduction:Malignant otitis externa is a life-threatening infection of the skull base. Its presentation is not always typical.Case reports:We report three cases of malignant otitis externa which illustrate the diversity of its clinical manifestations and the difficulties in its diagnosis.Discussion:The perception of malignant otitis externa as an infection caused by Pseudomonas aeruginosa in diabetic patients is not always correct. The adoption of diagnostic criteria could be helpful in identifying atypical cases.

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Increasing burden of necrotizing otitis externa: our experience of 38 cases

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20211581 ◽

2021 ◽

Vol 7 (5) ◽

pp. 853

Author(s):

Dheeraj Lambor ◽

Kanhai R. Naik ◽

Carnegie DeSa ◽

Swati Lambor ◽

Ruby Samuel

Keyword(s):

Otitis Externa ◽

Nerve Palsy ◽

Clinical Presentation ◽

Facial Nerve Palsy ◽

Treatment Modalities ◽

Diabetic Patients ◽

Significant Morbidity ◽

Necrotizing Otitis Externa ◽

Objective Being ◽

Antibiotic Combination

Background: Necrotizing otitis externa is an infection affecting immune-compromised and elderly diabetic patients resulting in complications with significant morbidity and mortality. We present our experience with this disease, along with the investigative tools and treatment modalities that benefitted most. The objective being to analyze the course of the disease and the benefit of having an institutional protocol for its management.Methods: This is a retrospective observational study on patients diagnosed with necrotizing otitis externa between 2013-2019.Results: Out of 38 patients 36 were diabetics, the commonest clinical presentation included otalgia in 37 patients, granulations in 35, facial nerve palsy in 14 and Pseudomonas aeruginosa was isolated in 19 patients. They were managed with multidrug combination antibiotic therapy, topical dressing and drops with 27 showing improvement.Conclusions: We recommend a diagnostic triad for NOE comprising of otalgia in an elderly diabetic patient with granulations in the external auditory canal. It is best managed by controlling diabetes, appropriate antibiotic combination, topical dressing, and sometimes surgical debridement.

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Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistics trends

The Journal of Laryngology & Otology ◽

10.1017/s002221511500105x ◽

2015 ◽

Vol 129 (6) ◽

pp. 600-603 ◽

Cited By ~ 16

Author(s):

G Chawdhary ◽

N Liow ◽

J Democratis ◽

O Whiteside

Keyword(s):

Otitis Externa ◽

Severe Infection ◽

Fold Increase ◽

Antibiotic Resistant ◽

Catchment Population ◽

Malignant Otitis Externa ◽

The Mean ◽

The Uk ◽

High Index Of Suspicion ◽

Park Hospital

AbstractBackground:Necrotising (malignant) otitis externa is a severe infection causing temporal bone osteomyelitis. Although rare, our experience (reported herein) shows local doubling of cases in 2013. Hospital Episodes Statistics data for England over 14 years also indicate increased incidence nationally. Specific learning points in management are also discussed.Methods:A retrospective review was conducted of patients admitted in 2013 to Wexham Park Hospital, Slough, UK (catchment population, 450 000). In addition, the UK Government Hospital Episodes Statistics data were interrogated.Results:There were five cases of necrotising (malignant) otitis externa in 2013, representing a local doubling on previous years. The mean age of patients was 82 years. All cultures grew Pseudomonas aeruginosa; no isolates were antibiotic resistant. All patients responded to systemic anti-pseudomonals on clinical, biochemical and radiological parameters. Hospital Episodes Statistics data showed a six-fold increase in the number of cases from 1999 (n = 67) to 2013 (n = 421).Conclusion:Our experience suggests increasing necrotising (malignant) otitis externa incidence, and retrospective analysis of Hospital Episodes Statistics data supports this observation. Necrotising (malignant) otitis externa poses challenges in management, as exemplified in our cases, requiring a high index of suspicion and early aggressive treatment to achieve cure.

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Peritoneal Tuberculosis Presenting as Chronic Ascites With Scrofula: A Case Report

Clinical Management Issues ◽

10.7175/cmi.v13i1.1416 ◽

2019 ◽

Vol 13 (1) ◽

Author(s):

Galina Bogoslovskaya ◽

Jose Zaldivar

Keyword(s):

Case Report ◽

Early Diagnosis ◽

Extrapulmonary Tuberculosis ◽

Young Female ◽

Ca 125 ◽

Test Results ◽

Peritoneal Tuberculosis ◽

Clinical Presentations ◽

High Index Of Suspicion ◽

Diagnostic Delays

Peritoneal tuberculosis (PTB) is a common type of extrapulmonary tuberculosis; however, due to variety of clinical presentations, diagnostic challenges do occur. The nonspecific features of this disease can lead to diagnostic delays and the development of complications. In addition, PTB can mimic a malignancy, especially in women who present with ascites and elevated cancer antigen (CA) 125 levels. A high index of suspicion is an important factor in an early diagnosis. Moreover, an early diagnosis and the initiation of antituberculous therapy are essential for preventing morbidity and mortality. Fortunately, most of these patients respond very well to standard antituberculous therapy.Here, we have reported the case of a young female patient who presented with chronic ascites, mild abdominal tenderness, and later, scrofula. Ultimately, she was diagnosed with PTB based on her test results. We expect that this case report will contribute to the existing literature on this subject.

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Malignant Otitis Externa with Skull Base Osteomyelitis

Emergencies in Otorhinolaryngology ◽

10.5005/jp/books/12240_12 ◽

2014 ◽

pp. 178-178

Author(s):

GC Sahoo

Keyword(s):

Skull Base ◽

Otitis Externa ◽

Skull Base Osteomyelitis ◽

Malignant Otitis Externa

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Advanced Imaging Techniques in Skull Base Osteomyelitis Due to Malignant Otitis Externa

Current Radiology Reports ◽

10.1007/s40134-018-0263-y ◽

2018 ◽

Vol 6 (1) ◽

Cited By ~ 21

Author(s):

A. M. J. L. van Kroonenburgh ◽

W. L. van der Meer ◽

R. J. P. Bothof ◽

M. van Tilburg ◽

J. van Tongeren ◽

...

Keyword(s):

Skull Base ◽

Otitis Externa ◽

Imaging Techniques ◽

Advanced Imaging ◽

Skull Base Osteomyelitis ◽

Malignant Otitis Externa

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Scrotal Ulcer is a Rare Presentationof TB Epididymis in Young Male

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i55b33858 ◽

2021 ◽

pp. 146-149

Author(s):

Rekadi Srinivasa Rao ◽

Senthil Kumar ◽

R. Anantharamakrishnan ◽

P. Varadaraju

Keyword(s):

Case Report ◽

Early Diagnosis ◽

Clinical Presentation ◽

Young Male ◽

High Index ◽

History Of ◽

Scrotal Swelling ◽

High Index Of Suspicion

Introduction: Scrotal tuberculosis (TB) is rare and may present as painful scrotal swelling with ulceration and discharging sinus. Case Report: A 28 years male with 2 months history of swelling and pain over left scrotum. Developed ulcer over the scrotal region with multiple sinus associated with pus discharge. Conclusion: The clinical presentation of TB scrotal ulcer can be atypical and a high index of suspicion is required for early diagnosis. Diagnosis is by using ultrasonography, microbiology, and biopsy. Treatment requires prolonged ATT for 6 months.

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