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Necrotizing otitis externa: 19 cases’ report

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Abstract

Necrotizing otitis externa is an uncommon but severe infectious disease of the external auditory canal. Patients at risk are those immunodepressed or having diabetes. The causal germ is often Pseudomonas aeruginosa. Over a period of 10 years (1997–2006), we treated 19 patients: 94.7% had diabetes (insulin dependent in 6 cases). The causal germ was P. aeruginosa in 59% of cases. The pretherapeutic work-up included a computed tomography and a scintigraphy practiced in order to confirm diagnosis and assess the extension. Medical treatment was based on a parenteral antibiotic therapy using a third-generation cephalosporin and a fluoroquinolones. Local treatment of the auditory canal including cleaning and application of antimicrobial agents was performed in all the cases. Surgical debridement of soft tissue and infected bone was performed in one patient who did not respond to medical management. Repeated scintigraphies with gallium were used to follow the course under treatment in only three cases. We had a 89.4% cure rate with only three cases of recurrence. We reviewed the data in the literature on necrotizing otitis externa and present the important diagnostic, imaging, and therapeutic aspects of the disease.

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References

  1. Grandis JR, Branstetter BF, Yu VL (2004) The changing face of malignant external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis 4:34–39

    Google Scholar 

  2. Thiagarajah R, Chapman P, Irvine A (2008) Malignant otitis externa or malignancy: report of two cases. Eur J Radiol 67:9–12

    Article  Google Scholar 

  3. Kwona BJ, Hana MH, Ohd SH, Song JJ, Chang KH (2006) MRI findings and spreading patterns of necrotizing external otitis: is a poor outcome predictable? Clin Radiol 61:495–504

    Article  Google Scholar 

  4. Patmore H, Jebreel A, Uppal S, Raine CH, McWhinney P (2009) Skull base infection presenting with multiple lower cranial nerve palsies. Am J Otolaryngol (in press)

  5. Grandis JR, Branstetter BF, Yu VL (2004) The changing face of malignant external otitis: clinical, radiological and anatomic correlations. Lancet Infect Dis 4:34–39

    Article  Google Scholar 

  6. Harbaoui I (2007) L’otite externe nécrosante à propos de 19 cas. Thèse de médecine faculté de médecine de Tunis

  7. Malard O, Beauvillain de Montreuil C, Legent F (2005) Pathologie acquise de l’oreille externe. Otorinolaringologie 2:263–289

    Google Scholar 

  8. Bokowy C, Cadot M, Lelièvre G (1995) Pathologie acquise de l’oreille externe. Encycl Méd Chir, Oto-rhino-laryngologie 20-070-A-10. Elsevier, Paris, 14p

  9. Stroman DW, Roland PS, Dohar J, Burt W (2001) Microbiology of normal external auditory canal. The laryngoscope 111:2054–2059

    Article  CAS  PubMed  Google Scholar 

  10. Cunningham M, Yu VL, Turner J, Curtin H (1988) Necrotizing otitis externa due to Aspergillus in an immunocompetent patient. Arch Otolaryngol Head Neck Surg 114:554–556

    CAS  PubMed  Google Scholar 

  11. Barrow HN, Levenson MJ (1992) Necrotizing “malignant” External otitis caused by staphylococcus epidermidis. Arch Otolaryngol Head Neck Surg 118:94–96

    CAS  PubMed  Google Scholar 

  12. Chandler JR (1968) Malignant external otitis. Laryngoscope 78:1257–1294

    Article  CAS  PubMed  Google Scholar 

  13. Bagdade JD, Nielson K, Root R, Bulger R (1970) Host defense in diabetes mellitus: the feckless phagocyte during poor control and ketoacidosis. Diabetes 19:364

    Google Scholar 

  14. Facon F, Braccini F, Ayache A (2000) Otite externe maligne: approche diagnostique et thérapeutique. J F ORL 49:270–275

    Google Scholar 

  15. Martel J, Guyot M, Darrouzet V (1999) Otites externes «malignes» ou nécrosantes progressives. Revue de l’ACOMEN 5:405–415

    Google Scholar 

  16. Joachims HZ (1976) Malignant external otitis in children. Arch Otolaryng USA 102:236–237

    CAS  Google Scholar 

  17. Karantanas AH, Karantzas G, Katsiva V, Sandris V (2003) CT and MRI in malignant external otitis: a report of four cases. Comput Med Imaging Graph 27:27–34

    Article  CAS  PubMed  Google Scholar 

  18. Mardinger O, Rosen D, Minkon B, Tulzinsky Z, Ophir D, Hirsberg A (2003) Temporomandibular joint involvement in malignant external otitis. Oral Surg Oral Pathol Oral Radiol Endod 96:398–403

    Article  Google Scholar 

  19. Bouccara D, Simon-Blancal V, Rodallec M, Cyna-Gorse F, Mosnier I, Fantin B, Sterkers O (2007) Ostéomyélite de la base du crâne d’origine otosinusienne: étude d’une série de cinq cas récents. Ann Otolaryngol Chir Cervicofac 124:25–32

    CAS  PubMed  Google Scholar 

  20. Curtin HD, Wolfe P, May M (1982) Malignant external otitis: CT evaluation. Radiology 145:383–388

    CAS  PubMed  Google Scholar 

  21. Rubin J, Yu VL (1988) Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis and therapy. Am J Med 85:391–398

    Article  CAS  PubMed  Google Scholar 

  22. Holder CD, Gurucharri M, Bartels LJ, Colman MF (1986) Malignant external otitis with optic neuritis. Laryngoscope 96:1021–1023

    Article  CAS  PubMed  Google Scholar 

  23. Corey JP, Lewandowski RF, Panwalker AP (1985) Pronostic implication of therapy for necrotizing external otitis. Am J Otol 4:353–357

    Google Scholar 

  24. Ph Ceruse, Colleaux B, Truy E, Disant F, Morgon AH (1993) Les otites malignes externes. A propos de sept cas récents. Ann Otolaryngol 110:332–336

    Google Scholar 

  25. Marsot DK, Tiyriboz A, Meyer B et al (1991) Otite externe maligne, quand et quelle imagerie? Ann Otolaryngol 108:325–331

    Google Scholar 

  26. Devaney KO, Boschman CR, Willard SC, Ferlito A, Rinaldo A (2005) Tumours of the external ear and temporal bone. Lancet Oncol 6:411–420

    Article  PubMed  Google Scholar 

  27. Gold S, Som PM, Lucente FE, Lawson W, Mendelson M, Parisier SC (1994) Radiographic findings in progressive necrotizing external otitis. Laryngoscope 94:364–366

    Google Scholar 

  28. Garty I, Rosen G, Holdstein Y (1985) The radionuclide diagnosis, evaluation and follow-up of malignant external otitis. J Laryngol Otol 99:109–115

    Article  CAS  PubMed  Google Scholar 

  29. Peleg U, Perez R, Raveh D, Berelowitz D, Cohen D (2007) Stratification for malignant external otitis. Otolaryngol Head Neck Surg 137:301–305

    Article  PubMed  Google Scholar 

  30. Bonardel G, Gontier E, Soret M, Foehrenbach H (2009) Apport des techniques de médecine nucléaire dans la prise en charge des affections de la sphère oto-rhino-laryngologique. Otorinolaringologie 20-902-A-01

  31. Hern JD et al (1996) Malignant otitis externa in HIV and AIDS. J Otolaryngol 110:770–775

    CAS  Google Scholar 

  32. El Silimy O, Sharnuby M (1992) Malignant external otitis, management policy. J Laryngol Otol 106:5–6

    CAS  PubMed  Google Scholar 

  33. Pistorius B et al (1999) Prospective randomised, comparative trial of ciprofloxacin otic drops with or without hydrocortisone vs. polymyxine B-néomycin-hydrocortisone otic suspension in the treatment of acute diffuse otitis externa. Infect Dis clin Prat 8:387–395

    Article  Google Scholar 

  34. Cavallo JD (2000) Pseudomonas aeruginosa et β-lactamines. Précis de bactériologie Clinique. Eska, Paris, pp 678–687

  35. Ling S, Sader C (2008) Fungal malignant otitis externa treated with hyperbaric oxygen. Int J Infect Dis 12:550–552

    Article  PubMed  Google Scholar 

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The authors had no financial relationship with any organization that sponsored the research.

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Correspondence to Ali Mardassi.

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Hariga, I., Mardassi, A., Belhaj Younes, F. et al. Necrotizing otitis externa: 19 cases’ report. Eur Arch Otorhinolaryngol 267, 1193–1198 (2010). https://doi.org/10.1007/s00405-009-1194-2

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  • DOI: https://doi.org/10.1007/s00405-009-1194-2

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