Use of magnetic resonance imaging as the primary imaging modality in the diagnosis and follow-up of malignant external otitis

Abstract

Malignant external otitis (MEO) is a severe infection of the external auditory meatus caused by Pseudomonas aeruginosa. Classical features include unrelenting deep otalgia, otorrhoea and granulations in the floor of the ear canal. Treatment is generally protracted antibiotic therapy and monitoring of inflammatory markers; the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Traditionally computed tomography (CT) has been the imaging modality of choice. The authors present a case where magnetic resonance imaging (MRI) has been crucial in the diagnosis and follow up of a patient with MEO.

Diffusion-weighted Magnetic Resonance Imaging as a Novel Imaging Modality in Assessing Treatment Response in Necrotizing Otitis Externa

“…Radionuclide imaging for assessment of inflammatory activity is also utilized and modalities include threephase technetium Tc-99m bone scans, leukocyte scintigraphy, gallium Ga-67 scintigraphy, single-proton emission computed tomography, and fludeoxyglucose positon emission tomography. However, the use of this modality is limited by low specificity, high cost, risks of ionizing radiation, elaborate preparation of radionuclides, and limited availability (6)(7)(8).…”

Malignant Otitis Externa (MOE) causing cerebral abscess and facial nerve palsy

“…Computed tomography (CT) scanning is considered the appropriate initial imaging study, however, there are mixed reports about whether a CT scan alone is enough to evaluate disease severity and its complications 15. While CT scan is quite sensitive for demonstrating bony destruction associated with MOE, MRI is better at detecting the soft tissue changes associated with MOE and more useful for following disease resolution after treatment 16…”

Pseudomonas Infection of the Temporomandibular Joint (TMJ) Health and Public Health Issues

“…In his work, he reported the occurence of TMJ disease of up to 14%. Doroghazi et al (1981( , in Drew, 1993 described how, in a group of 21 patients with symptoms of external invasive otitis, 5 patients had symptoms of TMJ damage ( Ismail, 2004).…”