Necrotizing External Otitis

Franco-Vidal, V.; Blanchet, Harold; Bebear, Cécile; Dutronc, H.; Darrouzet, V.

doi:10.1097/mao.0b013e31805153bd

Cited by 115 publications

(67 citation statements)

References 8 publications

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“…Other very rare cause which has not been previously reported is actinomycosis. The most common presenting symptoms are otolgia and otorrhea, as suggested by Blanchet et al [3] The hallmark finding is granulation tissue at the bony-cartilaginous junction. Initially infection is confined to the ear canal, but as it progresses, it involves the facial nerve followed by lower cranial nerves (IX, X, XI, XII), as suggested by Mani et al [4] The work-up includes computed tomography, technetium, and gallium bone scan to follow course under treatment.…”

Section: Introductionmentioning

confidence: 92%

“…Initially infection is confined to the ear canal, but as it progresses, it involves the facial nerve followed by lower cranial nerves (IX, X, XI, XII), as suggested by Mani et al [4] The work-up includes computed tomography, technetium, and gallium bone scan to follow course under treatment. [3,4] Treatment is mainly medical with antipseudomonal drugs such as fluoroquinolone. Surgery should be left for extensive and refractory cases.…”

Section: Introductionmentioning

confidence: 99%

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Unexpected cause of malignant otitis externa: A rare case report

2011

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Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Unexpected cause of malignant otitis externa: A rare case report

2011

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“…Other possible pathogens are: Staphylococcus aureus [2] [6], Staphylococcus epidermidis [7] [8], Proteus mirabilis [9], Klebsiella oxytoca [10] [11] and fungi [12], such as Aspergillus fumigatus [13]. Diabetes mellitus or other conditions that compromise immune system, such as acquired immunodeficiency syndrome, malignancy, chemotherapy could represent risk factors [2] [14] [15].…”

Section: Introductionmentioning

confidence: 99%

Staphylococcus Aureus Malignant External Otitis

Ricciardiello¹,

Cavaliere²,

Oliva³

et al. 2014

AiM

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Malignant external otitis is a severe infection of the external auditoy canal, characterized by high gravity and mortality. It can arrive to skull base and originate intracranial complications. The most frequent pathogenic agent is Pseudomonas aeruginosa. Authors described two cases of external malignant otitis caused by Staphylococcus aureus, explaining clinical features, progression, diagnostic and therapeutic approach, prognosis of this disease. A comparison between Pseudomonas aeruginosa and Staphylococcus aureus malignant otitis was described, associated with a literature analysis.

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“…5,9 A recent case series of 46 patients treated for NOE quoted healing rates over 95% after a mean follow-up of around 78 weeks. 18 Cranial nerve palsy as a complication of NOE is well recognised, but debate remains about whether this feature has prognostic value. The facial nerve is most commonly affected because of the close relationship of the stylomastoid foramen to the external auditory canal.…”

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confidence: 99%

“…However, higher rates of mortality have not been demonstrated. [18][19][20] Temporomandibular joint (TMJ) involvement is rare and may reflect more advanced disease with worse prognosis. Data are limited: one case series of 42 people with NOE identified six patients with TMJ involvement, and reported a 50% mortality rate directly related to the infection within the TMJ group.…”

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confidence: 99%

Necrotising otitis externa: an unusual cause of cranial nerve palsy in a diabetic haemodialysis patient

Zammit-Maempel²,

Stafford³

et al. 2010

JRCPE

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A 77-year-old South Asian man presented to the acute admissions service with a one-month history of progressive, left-sided facial weakness and left-sided mandibular and pre-auricular pain. A diagnosis of Bell's palsy was made. He was receiving ongoing treatment for ipsilateral otitis externa with topical tri-adcortyl ointment. His medical history included end-stage renal disease (ESRD) of uncertain cause, treated with hospital haemodialysis; poorly controlled insulin-treated type 2 diabetes mellitus; ischaemic heart disease; and gout.Unfortunately, the patient's symptoms continued to deteriorate and he was admitted to renal services from the haemodialysis unit. On examination he had periauricular tenderness and purulent discharge from the left auditory canal and associated conductive hearing loss. There was a left lower motor neurone facial palsy, with grade III upper division involvement and grade IV lower division involvement (House-Brackmann classification).1 Other cranial nerves were spared. Inflammatory markers were mildly elevated with a C-reactive protein of 71 mg/l. Glycosylated haemoglobin (HbA1c) of 10.7% reflected recent poor glycaemic control. Left-sided otoscopy revealed posteroinferior perforations of the tympanic membrane, with debris and mucopurulent discharge on the left, and pure-tone audiometry confirmed conductive deafness. A contrast-enhanced computerised tomography (CT) scan demonstrated soft tissue thickening in the external auditory canal and a 2.7 x 1.3 cm mass below the left skull base, engulfing the carotid artery and severely compressing the internal jugular vein. The mass extended through the parapharyngeal space onto the lateral pterygoid and deep temporalis muscles (Figure 1). Auricular swabs grew Aspergillus flavus and Proteus mirabilis.A diagnosis of necrotising (malignant) otitis externa (NOE) was made. The patient was treated for a total of six weeks with systemic agents and localised intraauricular ribbon gauze. He completed four weeks of intravenous meropenem (1 g once daily), combined with oral ciprofloxacin (250 mg twice daily) and voriconazole (400 mg mane, 200 mg nocte). Thereafter he continued with a further two weeks of oral ciprofloxacin and voriconazole. Doses were adjusted for the renal impairment and haemodialysis requirements. Topical ribbon gauze soaked with amphotericin and nystatin was administered daily over this period. The initial treatment was based upon the likelihood that Pseudomonas is the usual causative agent, and that resistant strains of Pseudomonas are increasingly prevalent. Culture results guided treatment thereafter.Two months later the facial nerve palsy was improving so that the lower division involvement had reduced to grade II weakness. Otoscopy confirmed reduced suppurative discharge with ongoing dry perforation of the tympanic membrane. Follow-up CT scans at three months and then seven months from diagnosis showed continuing improvement (Figure 2). DISCUSSIONThis case highlights a number of key learning points. The ESRD and diabetic populat...

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Necrotizing External Otitis

Abstract: The association of ciprofloxacin and ceftazidime was efficient in countering the increasing resistance of P. aeruginosa to quinolones. We propose a prognostic classification of necrotizing external otitis based on the presence of facial paralysis and/or systemic factors.

Cited by 115 publications

References 8 publications

Unexpected cause of malignant otitis externa: A rare case report

Unexpected cause of malignant otitis externa: A rare case report

Staphylococcus Aureus Malignant External Otitis

Necrotising otitis externa: an unusual cause of cranial nerve palsy in a diabetic haemodialysis patient

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