A Treatment Protocol for Management of Bacterial and Fungal Malignant External Otitis: A Large Cohort in Tehran, Iran

Hasibi, Mehrdad; Ashtiani, Mohammadtaghi Khorsandi; Zarandi, Masoud Motassadi; Yazdani, Nasrin; Borghei, Pedram; Kuhi, Ali; Dabiri, Sasan; Hosseini, Reza; Sardashti, Sara

doi:10.1177/0003489417710473

Cited by 32 publications

(43 citation statements)

References 28 publications

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“…It may result in directing the initial empiric antimicrobial against the most common causative microorganism, which is Pseudomonas aeruginosa (PSA), without considering fungal pathogens. It is noteworthy that PSA is also the normal flora of the external auditory canal, so initially positive microbiologic studies may be misleading and can delay the diagnosis of a fungal entity [4,15]. For the diagnosis of MOE, samples of discharge from the auditory canal are usually sent for microbiology examination and culture, and tissue biopsies of granulation tissue from the auditory canal or the skull base can be examined, as was done in our patient [4] .…”

Section: Discussionmentioning

confidence: 99%

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Fungal Malignant Otitis Externa Involves a Cascade of Complications Culminating in Pseudoaneurysm of Internal Maxillary Artery: A Case Report

et al. 2019

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Patient: Male, 66 Final Diagnosis: Pseudoaneurysm of internal maxillary artery secondary to fungal malignant otitis externa Symptoms: Epistaxis Medication: — Clinical Procedure: Functional endoscopic sinus surgery, endovascular embolization Specialty: Infectious Diseases Objective: Unusual clinical course Background: Pseudomonal infection is the most common cause of malignant otitis externa (MOE), which typically affects elderly diabetic patients. Fungi are a rare cause of MOE. MOE can be life-threatening if not recognized and treated promptly. It can result in a wide spectrum of complications, including skull-base osteomyelitis, cranial nerve palsy, cerebral venous thrombosis, and brain abscess. Pseudoaneurysm formation of the intracranial vessels is a life-threatening complication of MOE that is seldom reported in the literature. Case Report: We report the case of a 66-year-old diabetic man with MOE who was initially treated with antipseudomonal antibiotics after negative initial culture results. His MOE resulted in a cascade of complications, including facial nerve palsy, skull base osteomyelitis, and sigmoid sinus thrombosis, and culminated in left maxillary artery pseudoaneurysm formation resulting in massive epistaxis and hemodynamic instability. Endovascular embolization resulted in a successful obliteration of the pseudoaneurysm. A subsequent functional endoscopic sinus surgical (FESS) tissue biopsy confirmed Candida glabrata as the etiological agent. The patient was successfully treated with antibiotics and antifungal and anticoagulation therapy, and was discharged home in good condition. Conclusions: A high index of suspicion for the diagnosis of fungal MOE, particularly in intractable cases of MOE with negative initial cultures, should be maintained. Pseudoaneurysm formation is a life-threatening complication of MOE that is seldom reported in the literature and should be suspected in any patient with MOE who presents with epistaxis or intracranial bleeding.

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Section: Discussionmentioning

confidence: 99%

“…are the etiologic agents in 5% to 20% of cases. Fungi cause MOE in 5% to 20% of these patients [1–4]. The infection begins as an external otitis that progresses into osteomyelitis of the temporal bone.…”

Section: Introductionmentioning

confidence: 99%

Fungal Malignant Otitis Externa Involves a Cascade of Complications Culminating in Pseudoaneurysm of Internal Maxillary Artery: A Case Report

et al. 2019

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“…4,5 Pseudomonas aeruginosa is causative in over 90% of cases, but Staphylococci, Streptococci, and gram-negative bacteria have also been implicated. 2,6 Recent studies on MOE have reported increased pathogen diversity. In addition to increased rates of quinolone-resistant Pseudomonas, there have been reported cases of Streptococci, Staphylocci, and gram-negative pathogens.…”

Section: A Unique Case Of Malignant Otitis Externamentioning

confidence: 99%

A Unique Case of Malignant Otitis Externa

et al. 2019

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“…Some patients don’t respond to this treatment because of fungal infection (e.g. Aspergillus spp , Candida spp ) [ 10 ]. This literature review was designed to examine the clinical picture, therapy and follow-up in patients affected by advanced MEO owing to diagnostic delay.…”

Section: Introductionmentioning

confidence: 99%

Malignant Otitis External: Our Experience and Literature Review

et al. 2020

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Case series Patients: Male, 74-year-old • Male, 76-year-old • Male, 77-year-old Final Diagnosis: Malignant otitis externa Symptoms: Edema • facial paralysis • hearing loss • otalgia and major otorrhea in the right ear Medication: — Clinical Procedure: ENT examination Specialty: Otolaryngology Objective: Unusual clinical course Background: Malignant external otitis (MEO) is an invasive infection that can involve the external auditory canal and the skull base up to the contiguous soft tissues. Considering the changing face of MEO, we reviewed cases of MEO treated in our Ear Nose Throat (ENT) clinic – University Federico II of Naples between 2018 and 2019 to evaluate the current epidemiology of the condition and to assess the state of art on diagnosis, therapeutic and follow-up management in our patients. Case Reports: We present the cases of three male patients with Type 2 diabetes mellitus who complained of long-lasting otorrhea and pain, with clinical suspicion of MEO. In all cases, ear swab was positive for Pseudomonas aeruginosa . All our patients received a 6-week course of intravenous ciprofloxacin, piperacillin, and tazobactam, with rapid clinical symptoms improvement and complete recovery at 1-year follow-up. Conclusions: MEO is difficult to treat due to the lack of standardized care guidelines. Patients with MEO often present with severe otalgia, edema, otorrhea, and facial nerve paralysis. Clinicians must suspect MEO in elderly diabetic and immunocompromised patients with persistent otalgia after external otitis. Imaging (computed tomography and magnetic resonance imaging) can play synergistic roles in the management of MEO. To evaluate eradication of the disease, clinicians have to assess clinical symptoms and signs as well as radiological imaging and inflammatory markers.

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A Treatment Protocol for Management of Bacterial and Fungal Malignant External Otitis: A Large Cohort in Tehran, Iran

Abstract: Our findings provide evidence to develop clinical guidelines that accelerate diagnosis and treatment of MOE to improve patient outcomes.

Cited by 32 publications

References 28 publications

Fungal Malignant Otitis Externa Involves a Cascade of Complications Culminating in Pseudoaneurysm of Internal Maxillary Artery: A Case Report

Fungal Malignant Otitis Externa Involves a Cascade of Complications Culminating in Pseudoaneurysm of Internal Maxillary Artery: A Case Report

A Unique Case of Malignant Otitis Externa

Malignant Otitis External: Our Experience and Literature Review

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