Objectives Malignant external otitis (MEO) is a potentially fatal infection of the external auditory canal, temporal bone, and skull base. Despite treatment with modern antibiotics, MEO can lead to skull base osteomyelitis. Until now, there have been few studies on the prognostic factors of MEO.Methods We performed a retrospective study to identify prognostic factors of MEO, and a meta-analysis of other articles investigating MEO. On the basis of disease progression the 28 patients in our study were divided into ‘controlled’ and ‘uncontrolled’ groups, consisting of 12 and 16 patients, respectively. We identified three categories of prognostic factors: those related to patient, disease, and treatment. We compared these prognostic factors between the controlled and uncontrolled groups.ResultsIn our study, the duration of diabetes mellitus (DM), presence of inflammatory markers (C-reactive protein and erythrocyte sedimentation rate), and computed tomography or magnetic resonance imaging findings influenced the prognosis of MEO. In contrast, prognosis was unrelated to age, gender, mean glucose level, hemoglobin A1c level, pathogen, comorbidity, or cranial nerve involvement. No factor related to treatment modality was correlated with prognosis, such as surgery, steroid therapy, or interval to the first appropriate treatment. Cranial nerve involvement has been proven to be associated with disease progression, but the relationship between cranial nerve involvement and the prognosis of MEO remains controversial. As a part of this study, we conducted a meta-analysis of cranial nerve involvement as a prognostic factor of MEO. We found that cranial nerve involvement has a statistically significant influence on the prognosis of MEO.Conclusion We found that glycemic control in diabetes mellitus, cranial nerve involvement, and the extent of disease determined from various imaging modalities influence the prognosis of MEO. We suggest that significant prognostic factors should be monitored to determine the prognosis of patients with MEO.
Background and Objectives:Positional therapy is a therapeutic method for obstructive sleep apnea (OSA). However, little is known about the effectiveness of positional OSA treatment based on meta-analysis. Therefore, we undertook a review and meta-analysis of studies to assess the effect of positional therapy on OSA. Subjects and Method: We searched PubMed (Medline), OVID Medline, EMBASE, Cochrane Library, SCOPUS, KoreaMed, MedRIC, and KSI KISS using the key words "obstructive sleep apnea" and "positional therapy". To estimate the effect of positional OSA therapy, we analyzed the ratio of means (ROM) for pre-and post-treatment polysomnographic data including apnea-hypopnea index (AHI), lowest oxygen saturation, arousal index, and sleep efficiency. Results: Finally, twenty two studies from 21 papers were included in the meta-analysis. Positional therapy significantly decreased AHI by 54.1% [ROM, 0.459; 95% confidence interval (CI), 0.394 to 0.534] and increased lowest oxygen saturation by 3.3% (ROM, 1.033; 95% CI, 1.020 to 1.046). However, positional therapy did not significantly change arousal index (ROM, 0.846; 95% CI, 0.662 to 1.081) or sleep efficiency (ROM, 1.008; 95% CI, 0.990 to 1.027). Conclusion: Positional therapy significantly improves respiratory parameters including AHI and lowest oxygen saturation in patients with OSA.
Background and ObjectivesZZPediatric obstructive sleep apnea (OSA) can have an effect on the quality of life (QOL) such as behavior, school performance, emotional distress and daytime function. We aim to verify changes in sleep disordered breathing based on polysomnographic findings and disease specific health related QOL before and after adenotonsillectomy in Korean children with OSA. Subjects and MethodZZA total 20 children aged 3 through 13 years old (mean age=6.7 years old and male/female=14/6) with OSA were included. We evaluated respiratory disturbances in patients using the standard polysomnography and the OSA-specific health related QOL based on Korean Obstructive Sleep Apnea-18 Survey (KOSA-18). ResultsZZThere were significant improvements in apnea-hypopnea index (from 9.4±7.4 to 1.1±0.8 events/hour, p<0.001) and total score of KOSA-18 (71.3±26.0 to 33.6±10.7, p<0.001) after adenotonsillectomy. ConclusionZZSleep disordered breathing and QOL improve significantly after adenotonsillectomy in Korean OSA children.
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