Complicated necrotizing otitis externa in diabetic patients

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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Necrotizing Otitis Externa: A Disease Barely Known to Neurosurgeons

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0036-1596052 ◽

2016 ◽

Vol 38 (03) ◽

pp. 239-245

Author(s):

Sérgio Augusto Vieira Cançado ◽

Lucídio Duarte de Souza ◽

Rodrigo Moreira Faleiro ◽

José Maurício Siqueira

Keyword(s):

Early Diagnosis ◽

Skull Base ◽

Otitis Externa ◽

Clinical Presentation ◽

Neurological Impairment ◽

Diabetic Patients ◽

Necrotizing Otitis Externa ◽

Clinical Presentations ◽

Malignant Otitis Externa ◽

High Index Of Suspicion

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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Benign necrotizing otitis externa

Scott-Brown's Otorhinolaryngology: Head and Neck Surgery 7Ed ◽

10.1201/b15118-264 ◽

2008 ◽

pp. 3332-3335 ◽

Cited By ~ 1

Author(s):

James Loock

Keyword(s):

Otitis Externa ◽

Necrotizing Otitis Externa

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Otitis Externa and Necrotizing Otitis Externa

Principles and Practice of Pediatric Infectious Diseases ◽

10.1016/b978-0-323-40181-4.00030-x ◽

2018 ◽

pp. 223-225.e1

Author(s):

Thomas G. Boyce ◽

Karthik Balakrishnan

Keyword(s):

Otitis Externa ◽

Necrotizing Otitis Externa

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Necrotizing otitis externa: 19 cases’ report

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-009-1194-2 ◽

2010 ◽

Vol 267 (8) ◽

pp. 1193-1198 ◽

Cited By ~ 23

Author(s):

Ines Hariga ◽

Ali Mardassi ◽

Faten Belhaj Younes ◽

Mohamed Ben Amor ◽

Sarra Zribi ◽

...

Keyword(s):

Otitis Externa ◽

Necrotizing Otitis Externa

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The external ear

Oxford Handbook of ENT and Head and Neck Surgery ◽

10.1093/med/9780199550791.003.05 ◽

2009 ◽

pp. 73-88

Author(s):

Rogan Corbridge ◽

Nicholas Steventon

Keyword(s):

Otitis Externa ◽

Congenital Abnormalities ◽

Structure And Function ◽

External Ear ◽

Necrotizing Otitis Externa ◽

And Function

Structure and function of the external ear 74 Congenital abnormalities 76 Infection of the pinna 78 Trauma to the pinna 80 Otitis externa 82 Necrotizing otitis externa 84 Malignancy of the pinna 86 Malignancy of the EAC 88 A working knowledge of the anatomy of the ear helps in documentation, correspondence, and in describing sites of lesions and trauma over the telephone. The main anatomical points are shown in ...

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