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.
Rhino-orbital cerebral mucormycosis is a rare but potentially severe fungal infection in children with high rate of morbidity and mortality. In pediatric patients, uncontrolled diabetes mellitus is considered to be a predisposing factor only in 15% of cases. To prevent and reduce mortality rate of this severe disease, early diagnosis based on clinical findings and biopsy is highly recommended. Herein, we report a case of rhino-orbital cerebral mucormycosis in a 12-year-old girl with type 1 diabetes to demonstrate that a multimodal management approach, involving early surgery which consists in frequent endoscopic sinus debridement and appropriate antifungal therapy, is essential to effectively reduce the spread of infection and achieve effective outcome.
Introduction la glande parotide est le siège préférentiel des tumeurs des glandes salivaires. Ces tumeurs sont rares mais se distinguent par une grande diversité histologique, posant ainsi des difficultés diagnostiques. L´imagerie par résonance magnétique (IRM) constitue actuellement le moyen d´imagerie le plus fiable dans l´exploration de ces tumeurs. Le but de notre étude était de préciser la valeur diagnostique de l'IRM et son rôle dans l'approche histopathologique de ces tumeurs. Méthodes il s´agissait d´une étude rétrospective descriptive et analytique ayant porté sur 50 cas de tumeurs de la parotide, opérés et pris en charge dans le service d´oto-rhino-laryngologie, et de chirurgie cervico-faciale de l´Hôpital Taher Sfar de Mahdia entre 2001 et 2019. Tous nos patients ont été explorés par une IRM parotidienne en préopératoire. Résultats parmi les 50 patients inclus dans notre étude, 36 (72%) présentaient une tumeur bénigne et 14 (28%) une tumeur maligne. La sensibilité de l´IRM pour le diagnostic de malignité était de 92,8% avec une spécificité de 97,2%, une valeur prédictive négative de 93% et une valeur prédictive positive de 97%. Concernant la caractérisation des tumeurs bénignes, l´IRM a évoqué le diagnostic de tumeur de Warthin dans tous les cas (13 cas) et le diagnostic d´adénome pléomorphe dans 22 cas parmi 23. Il y´avait 2 erreurs diagnostiqués: l´IRM a évoqué à tort le diagnostic d´adénome pléomorphe dans un cas de carcinome adénoïde kystique et elle a évoqué une tumeur maligne dans un cas d´adénome pléomorphe devant une restriction de diffusion. Conclusion l´IRM est hautement performante dans l´appréciation de la nature histologique de la tumeur parotidienne et surtout après l´avènement des nouvelles séquences fonctionnelles. Toutefois, seule l´analyse histologique permet de confirmer avec certitude le diagnostic de nature de la lésion.
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