This study showed that G3 EOM was unresponsive to conservative glucocorticoid treatment and required granulation tissue removal. Classification based on the middle ear pathology is useful for determining the most appropriate and successful treatment for EOM.
Postoperative fever following endoscopic endonasal surgery is a rare occurrence of concern to surgeons. To elucidate preoperative and operative predictors of postoperative fever, we analyzed the characteristics of patients and their perioperative background in association with postoperative fever. A retrospective review of 371 patients who had undergone endoscopic endonasal surgery was conducted. Predictors, including intake of antibiotics, steroids, history of asthma, preoperative nasal bacterial culture, duration of operation, duration of packing and intraoperative intravenous antibiotics on the occurrence of postoperative fever, and bacterial colonization on the packing material, were analyzed retrospectively. Fever (≥38 °C) occurred in 63 (17 %) patients. Most incidences of fever occurred on postoperative day one. In majority of these cases, the fever subsided after removal of the packing material without further antibiotic administration. However, one patient who experienced persistent fever after the removal of packing material developed meningitis. History of asthma, prolonged operation time (≥108 min), and intravenous cefazolin administration instead of cefmetazole were associated with postoperative fever. Odds ratios (ORs) for each were 2.3, 4.6, and 2.0, respectively. Positive preoperative bacterial colonization was associated with postoperative bacterial colonization on the packing material (OR 2.3). Postoperative fever subsided in most patients after removal of the packing material. When this postoperative fever persists, its underlying cause should be examined.
Learning Objectives: Although necrotizing otitis externa is life-threatened disease, it is difficult to be diagnosed and treated. Several points for diagnosis and the results of treatment would be reported. Necrotizing otitis externa is osteomyelitis of skull base originated from the floor of external auditory canal. Most of them are optimizing infection, mainly DM. Main pathogen is Pseudomonas Aeruginosa. Although clinical features are clear, it is difficult to reach a correct diagnosis. Symptoms are sometimes masked by antibiotics and analgesic drug. Severe pain, patient background such as DM, and granulation formation could be clue for suspicion. Both CT and MRI are useful for diagnosis and estimation for the extent of disease. Biopsy leads to definite diagnosis. First ling of treatment is conservative approach. Appropriate antibiotics should be chosen and patient backgroud disease would be controlled. Surgical intervention is useful when wellpneumatized mastoid is infected.
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