Diagnosis Of Malignant External Otitis Research Articles

Malignant externa otitis: the modern principles of diagnostics and treatment

The objective of the present study was to elucidate the specific features of the clinical course of malignant externa otitis in the context of the present-day concepts. A total of 5 patients presenting with the confirmed diagnosis of malignant external otitis were available for the examination. The analysis of the clinical observations provided the basis for the characteristic of pathogenesis of this condition, diagnostic principles, and treatment modalities for the management of the pathology in question. It is concluded that the patients suffering from malignant externa otitis must remain under medical care and observation during a long period and the strategy for the treatment of each concrete patient should be chosen on an individual basis taking into consideration the presence of concomitant pathologies and their adequate therapy.

Outcomes of malignant external otitis: survival vs mortality

Conclusions. In patients with malignant external otitis (MEO), mortality was not related to age, sex, degree of glucose tolerance, duration of diabetes mellitus (DM), microorganism, comorbid disease, or involvement of a single cranial nerve. Severe complications such as skull base osteomyelitis, intracranial extension, and involvement of multiple cranial nerves were correlated with mortality. Objectives. To analyze the factors that affect the survival of patients with MEO in today's era of advanced antibiotics. Patients and methods. Patients with a diagnosis of MEO from 1993 to 2005 were collected. Results. A total 26 patients with a mean age of 63.7±10.2 years were included. All had a history of DM. Pseudomonas aeruginosa (26.9%), Klebsiella pneumoniae (19.2%), and fungus (15.4%) were most frequently found in pus cultures. Cranial nerves were involved in 11 patients: the facial nerve was most frequently (38.46%) involved. Complications such as osteomyelitis (11 patients) and intracranial involvement (3 patients) were noted in this series. Mastoidectomy was performed in 12 patients. A total of five patients died.

Usefulness of CT scans in malignant external otitis: effective tool for the diagnosis, but of limited value in predicting outcome

Computerized tomography (CT) scanning is a well recognised tool for the diagnosis of malignant external otitis. To investigate the degree of correlation between CT findings scan and the patients clinical status focusing on a subgroup of patients with cranial nerve palsies. Diagnosis of malignant external otitis was confirmed in 23 patients (average age 71 years, age range 39-87) based on criteria of severe pain, otitis externa refractory to conventional treatments and possibly diabetes mellitus and pseudomonas detection. CT was performed on 23 of these patients. Results from these scans were analysed and correlated with patient clinical status. Retrospective analysis of CT images and medical notes were used for data analysis.The CT scans of all 23 patients showed evidence of involvement of disease outside the external auditory canal, confirming the diagnosis. Sixteen out of 23 patients (70%) demonstrated evidence of bone erosion. Four of the 16 showed involvement of the petrous apex. From our subset of ten patients with cranial nerve involvement, eight demonstrated evidence of bone erosion and two showed mastoid and middle ear involvement without bone erosion. All four patients with petrous apical involvement presented with cranial nerve palsies (two lower cranial nerve palsies, one seventh nerve palsy and one combined lower and seventh nerve palsy). CT scanning was found to be a fast and economical tool in the initial assessment of patients with malignant external otitis. Petrous apex involvement was constantly associated with cranial nerve palsies, usually the lower cranial nerves. CT findings of temporal bone in itself however, were not closely correlated to the clinical outcome of the patients.

Malignant external otitis in nondiabetic patients.

The purpose of this study is to point out that contrary to traditional belief, there is a small but significant group of nondiabetic patients with malignant external otitis. Thirty patients with a diagnosis of malignant external otitis were treated and followed up at the Department of Otolaryngology-Head and Neck Surgery, Beilinson Medical Center, between 1987 and 1991. Nine of these patients did not have clinical or laboratory evidence of diabetes. This study analyzes this group and concludes that the diagnosis of malignant external otitis should be considered by the treating physician in nondiabetic patients presenting with a Pseudomonas aeruginosa infection of the external ear canal. Severe pain and edematous closure of the canal, together with typical granulation tissue and failure to respond to medical treatment, are specific characteristics of this group.

Malignant external otitis in a diabetic adolescent

Malignant external otitis (MEO) is an unusual medical problem. The case reported is that of a diabetic adolescent who presented with severe ear pain unresponsive to oral antibiotics and analgesics. The diagnosis of MEO was made, and he was successfully treated with a combination of intravenous anti-Pseudomonas agents. A review of the pediatric cases, guidelines for diagnosis, length of treatment, and prognosis are presented.