Diagnosis and treatment of necrotising otitis externa and diabetic foot osteomyelitis – similarities and differences

Peled, Chilaf; Kraus, Mordechai; Kaplan, Daniel M.

doi:10.1017/s002221511800138x

Cited by 20 publications

(13 citation statements)

References 32 publications

(47 reference statements)

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“…The main pathogen isolated was P. aeruginosa followed by fungi. These results are similar to those described in some series ( Gahide et al., 2013 ; Glikson et al., 2016 ; Peled et al., 2018 , Peled et al., 2018 ). Other studies found that Staphylococcus aureus is isolated in second place after P. aeruginosa ( Hatch et al., 2018 ).…”

Section: Discussionsupporting

confidence: 92%

“…Resistance to local treatment, otitis externa, P. aeruginosa infection, otalgia, granulation tissue in the ear canal, hyperalgesic form, and local inflammation are the most commonly cited major criteria for NOE (G Chawdhary et al., 2017 ). Otalgia, otorrhea, and granulation tissue were the most frequent clinical signs, according to different studies ( Chawdhary et al., 2015 ; Gahide et al., 2013 ; Glikson et al., 2017 ; Peled et al., 2018 , Peled et al., 2018 ).…”

Section: Discussionmentioning

confidence: 97%

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Necrotising otitis externa: A single centre experience

Hasnaoui¹,

Mabrouk

Chelli

et al. 2021

Journal of Otology

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 97%

Necrotising otitis externa: A single centre experience

Hasnaoui¹,

Mabrouk

Chelli

et al. 2021

Journal of Otology

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“…Last, treatment protocol is similar and comprised of long term antibiotic treatment and surgery in selected cases. These similarities support previous assumptions that microangiopathies are probably the main pathology leading to NOE among DM patients 7,11 . If this is the case, it is reasonable to assume that DM duration and severity effects NOE progression.…”

Section: Discussionsupporting

confidence: 90%

Diabetes and Glycemic Control in Necrotizing Otitis Externa (NOE)

Peled

Sadeh

Saied

et al. 2020

Preprint

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Introduction: Although the association between necrotizing otitis externa (NOE) and diabetes mellitus (DM) is well known, there is little knowledge in regards to the effects of DM and glycemic control (preadmission and during hospitalization) on the outcome of NOE. The aim of the study was to determine the effects of DM duration and preadmission glycemic control, and in-hospital glycemic control on NOE severity. Methods: A retrospective case series analysis, including all patients between the years 1990-2018 hospitalized due to NOE were included in the study. Data collected included NOE disease characteristics, duration of DM, DM associated comorbidities, glycated hemoglobin (HbA1c), urine micro-albumin and in-hospital blood glucose measurements. Disease severity was defined based on duration of hospitalization (above or below 20 days) and need for surgery. Results: Eighty nine patients were included in the study. Eighty three patients (94.3%) had DM. Preadmission HbA1c was 8.13% (5.8%-12.6%). Forty nine patients (65.5%) had mean blood glucose of [?]140mg\dL and 26 patients (34.5%) had [?] 140mg/dL. DM duration was 157.88 months among NOE patients who required surgery, and 127.6 months among patients who were treated conservatively (p-value 0.25). HbA1c in patients hospitalized < 20 days was 7.6%, and 8.7% among NOE hospitalized [?] 20 days (p-value 0.027). Seven patients with mean blood glucose of [?]140mg\dL had Pseudomonas Aeruginosa (PA-NOE) (26.7%), in comparison to 25 patients (51.0%) with mean blood glucose measurement of [?]140mg\dL (p=0.045). Conclusions: HbA1c levels at admission are associated with longer hospitalization duration among NOE patients. High mean blood glucose during hospitalization was associated with a higher likelihood for a PA infection, however it had no effect on disease outcome.

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“…The prognosis appears to be related to the stage that the disease has extended at the onset of treatment. 22 This in turn needs great awareness of the condition.…”

Section: Discussionmentioning

confidence: 99%

Descriptive study on malignant otitis externa in diabetic patients at a tertiary care hospital at Madurandhagam

Thirumalaipriya

Madanagopal

2019

Int J Otorhinolaryngol Head Neck Surg

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Background: Malignant otitis external (MOE) is a destructive infection, principally affecting ageing diabetic patients. The present study directed for analysing various forms of clinical presentations, causative organisms and management of such diseases.Methods: We conducted a descriptive study of patients with MOE in the ENT Department of Karpaga Vinayaga Institute of Medical College and Hospital, Madurandhagam. Haematological, biochemical and epidemiological parameters were taken and result analysis was carried out. Results: They affect both the soft tissue and bones of immunocompromised patient’s predominantly diabetic patients. Various forms of clinical presentations such as ear discharge which proved to be due to Pseudomonas aeruginosa. Facial nerve involvement, osteonecrosis and bony erosion was noted in MOE patient.Conclusions: MOE or external otitis progressing necrosis is a serious infection of the subject often older and diabetic by P. aeruginosa.

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Diagnosis and treatment of necrotising otitis externa and diabetic foot osteomyelitis – similarities and differences

Cited by 20 publications

References 32 publications

Necrotising otitis externa: A single centre experience

Necrotising otitis externa: A single centre experience

Diabetes and Glycemic Control in Necrotizing Otitis Externa (NOE)

Descriptive study on malignant otitis externa in diabetic patients at a tertiary care hospital at Madurandhagam

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