Clinical Utility of a Polymerase Chain Reaction Assay in Culture-Negative Necrotizing Otitis Externa

Gruber, Maayan; Roitman, Ariel; Doweck, Ilana; Uri, Nechama; Shaked‐Mishan, Pninit; Kolop-Feldman, Aharon; Cohen‐Kerem, Raanan

doi:10.1097/mao.0000000000000563

Cited by 21 publications

(16 citation statements)

References 12 publications

(7 reference statements)

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“…Background Necrotizing (malignant) otitis externa is an aggressive, potentially life threatening infection occurring at the junction of the osseous and cartilaginous external auditory canal that can clinically resemble acute OE in its early stages [4]. Infection and inflammation spread from the osteocartilaginous junction or osseous canal along various anatomic routes; posteriorly toward the mastoid process, anteriorly/inferiorly via the fissures of Santorini ( Fig.…”

Section: Necrotizing Otitis Externa (Noe)mentioning

confidence: 99%

“…The term NOE is used in the remainder of this discussion. NOE predominantly affects elderly patients, and patients with diabetes or other conditions resulting in immunodeficiency [4,[9][10][11]. It has been suggested that microangiopathy or altered immune function increases the risk of developing infection or perpetuates infection in the area [12,13].…”

Section: Necrotizing Otitis Externa (Noe)mentioning

confidence: 99%

“…In one study, nearly a third of cultures failed to show growth [14]. In culturenegative NOE, the Pathology team may be consulted in select cases to evaluate the utility of pursuing testing such as a polymerase chain reaction (PCR) assay on tissue samples in order to maximize the possibility of detecting fungal or bacterial elements [4].…”

Section: Necrotizing Otitis Externa (Noe)mentioning

confidence: 99%

“…Treatment Management of NOE consists of local wound care, systemic antibiotic treatment ideally guided by cul- ture data and sensitivities, and where applicable, control of blood glucose. Surgery is reserved for local debridement or diagnostic procedures such as deep tissue sampling for biopsy and/or culture [4]. Antifungal therapy is based upon detection of fungal organisms [10].…”

Section: Differential Diagnosismentioning

confidence: 99%

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Idiopathic, Infectious and Reactive Lesions of the Ear and Temporal Bone

Magliocca

Vivas

Griffith

2018

Head and Neck Pathol

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A number of infectious, inflammatory and idiopathic lesions develop within otologic tissues that may share similar clinical and/or microscopic features. This review first provides a working classification for otitis externa, and then otitis media and includes two recently described entities, eosinophilic otitis media and otitis media with ANCA-associated vasculitis. Next, the microscopic findings of a spectrum of otopathologic conditions are described, including post-inflammatory conditions such as tympanosclerosis and aural polyps, an overview of animate aural foreign body as well as iatrogenic aural foreign body reactions. Finally, a review of fungal disease affecting the ear with a brief synopsis of Candida auris, a recently described and virulent organism, is presented.

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Section: Necrotizing Otitis Externa (Noe)mentioning

confidence: 99%

Section: Necrotizing Otitis Externa (Noe)mentioning

confidence: 99%

Section: Necrotizing Otitis Externa (Noe)mentioning

confidence: 99%

Section: Differential Diagnosismentioning

confidence: 99%

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Idiopathic, Infectious and Reactive Lesions of the Ear and Temporal Bone

Magliocca

Vivas

Griffith

2018

Head and Neck Pathol

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“…42 Diagnosis is made by culture 41 or perhaps by polymerase chain reaction assay. 43 Uncomplicated cases may be treated with 2% acetic acid in propylene glycol or 1% clotrimazole solution. 41 Fungi are occasionally the etiologic agents in malignant otitis externa.…”

Section: Fungal Acute Otitis Externamentioning

confidence: 99%

Freshwater Fungal Infections

Baumgardner

2017

Journal of Patient-Centered Research and Reviews

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Thirty‐Day Readmission and Prolonged Length of Stay in Malignant Otitis Externa

et al. 2019

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ObjectivesTo determine independent risk factors for 30‐day readmission, prolonged length of stay (PLOS), and discharge to a rehabilitation facility for those with malignant otitis externa.MethodsRetrospective cohort study of patients hospitalized with malignant otitis externa (International Classification of Diseases, 9th edition, code 380.14) in the Nationwide Readmissions Database (2013–2014). Overall and disease‐specific complication and mortality data were analyzed using chi‐squared and multivariate analysis.ResultsThere were 1267 cases of malignant otitis externa extracted. A PLOS of ≥8 days (90th percentile) was found in 14.2% (n = 180) of patients, and 13.7% (n = 174) were discharged to a facility. Patients were readmitted within 30 days at a rate of 12.5% (n = 159). The overall rates of uncomplicated and complicated diabetes were found to be 42.1% and 17.8%, respectively. Factors independently associated with PLOS included undergoing a surgical procedure (odds ratio [OR] 2.08, P < .001), and having central nervous system complications (OR 3.21, P < .001). Independent risk factors for disposition to a facility included nutritional deficiency (OR 1.91, P = .029), PLOS (OR 4.61, P < .001), and age 65–79 years (OR 6.57, P = .001). Readmission was independently linked to PLOS (OR 3.14, P < .001). Diabetes was not an independent risk factor for any outcome.ConclusionsThirty‐day readmission, PLOS, and ultimate discharge to a rehabilitation facility were common and closely intertwined. Despite the classic association between diabetes and malignant otitis externa, diabetes was not an independent risk factor for any of our outcomes.Level of Evidence4 Laryngoscope, 130:2220–2228, 2020

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Clinical Utility of a Polymerase Chain Reaction Assay in Culture-Negative Necrotizing Otitis Externa

Abstract: Patients who present with a refractory culture-negative NOE should be suspected as suffering from a fungal disease. The PCR assay may be an important laboratory adjunct in detecting pathogens responsible for NOE and can aid to promote therapy and disease resolution.

Cited by 21 publications

References 12 publications

Idiopathic, Infectious and Reactive Lesions of the Ear and Temporal Bone

Idiopathic, Infectious and Reactive Lesions of the Ear and Temporal Bone

Freshwater Fungal Infections

Thirty‐Day Readmission and Prolonged Length of Stay in Malignant Otitis Externa

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