Abstract
Purpose
High-resolution temporal bone computer tomography (HRTBCT) is the most common initial radiological modality used for the assessment of necrotizing otitis externa (NOE).
Objectives
(1) To compare the extension of disease, as seen on HRTBCT, in patients with NOE caused by different pathogens and (2) assess whether radiological findings may suggest the offending pathogen in cases of sterile-NOE.
Methods
All NOE patients were hospitalized between 1990 and 2018. All patients underwent HRTBCT at admission. Three groups (fungus-NOE, PA-NOE and sterile-NOE) comprising of ten patients each were randomly selected. HRTBCT was reevaluated by a senior radiologist. Thirteen radiological subsites were selected for reevaluation.
Results
All patients in the fungal-NOE group complained of otalgia, compared to nine in the sterile-NOE and six in the PA-NOE groups (p value = 0.044). External ear canal edema and granulation tissue were the most common findings in all groups. Surgery was performed in five patients in the fungal-NOE and PA-NOE and three in the sterile-NOE group (p value = > 0.05). Radiological findings indicating severe bone erosion within the EEC was seen in all patients but 3 (p value = > 0.05). Severe TMJ erosion was seen in one patient within the fungal-NOE and PA-NOE group (p value = > 0.05). When mild and severe involvement were combined, TMJ bone erosion was seen in four patients in the fungal-NOE and only in one patient in the PA-NOE (p = 0.04).
Conclusions
TMJ involvement may be more common in fungal disease, suggesting a different spreading pathway, as opposed to PA-NOE. Accordingly, TMJ involvement on HRTBCT may justify antifungal treatment in sterile culture-NOE.
Similar content being viewed by others
References
Mahdyoun P, Pulcini C, Gahide I, Raffaelli C, Savoldelli C, Castillo L, Guevara N (2013) Necrotizing otitis externa: a systematic review. Otol Neurotol 34:620–629
Peled C, El-Seid S, Bahat-Dinur A, Tzvi-Ran LR, Kraus M, Kaplan D (2019) Necrotizing otitis externa-analysis of 83 cases: clinical findings and course of disease. Otol Neurotol 40:56–62
Peleg U, Perez R, Raveh D, Berelowitz D, Cohen D (2007) Stratification for malignant otitis externa. Otolaryngol Head Neck Surg 137:301–305
Soudry E, Hamzany Y, Preis M, Joshua B, Hadar T, Nageris BI (2011) Malignant external otitis: analysis of severe cases. Otolaryngol Head Neck Surg 144:758–762
Stern Shavit S, Soudry E, Hamzany Y, Nageris BI (2016) Malignant external otitis: Factors predicting patient outcomes. Am J Otolaryngol 37:425–430
Cohen D, Friedman P (1987) The diagnostic criteria of malignant external otitis. J Laryngol Otol 101:216–221
Stevens SM, Lambert PR, Baker AB, Meyer TA (2015) Malignant otitis externa: a novel stratification protocol for predicting treatment outcomes. Otol Neurotol 36:1492–1498
van Kroonenburgh AMJL, van der Meer WL, Bothof RJP, van Tilburg M, van Tongeren MJ, Postma AA (2018) Advanced imaging techniques in skull base osteomyelitis due to malignant otitis externa. Cur Radiol Rep 6:3
Grandis JR, Curtin HD, Yu VL (1995) Necrotizing (malignant) otitis externa: prospective comparison of CT and MR imaging in diagnosis and follow up. Radiology 196:499–504
Rubin Grandis J, Brandstetter BF 4th, Yu VL (2004) The changing face of malignant (necrotizing) external otitis: clinical, radiological, and anatomic correlation. Lancet Infect Dis 4:34–39
Okpala NCE, Siraj QH, Nilssen E, Pringle M (2005) Radiological and radionuclide investigation of malignant otitis externa. J Laryngol Otol 119:71–75
Chakraborty D, Bhattacharya A, Kamaleshwaran KK, Agrawal K, Gupta AK, Mittal BR (2012) Single photon emission computed tomography/computed tomography of the skull in malignant otitis externa. Am J Otolaryngol 33(1):128–129
Nawaz A, Torigian DA, Siegelman ES, Basu S, Chryssikos T, Alavi A (2010) Diagnostic performance of FDG-PET, MRI, and plain film radiography (PFR) for the diagnosis of osteomyelitis in the diabetic foot. Mol Imaging Biol 12(3):335–342
Hamzany Y, Soudry E, Preis M, Hadar T, Hilly O, Bishara J, Nageris BI (2011) Fungal malignant external otitis. J Infect 62(3):226–231. https://doi.org/10.1016/j.jinf.2011.01.001
Acknowledgements
No sources of support require acknowledgment.
Funding
No funding was received for this work from any organization.
Author information
Authors and Affiliations
Contributions
CP contributed to research design, data analysis and writing. RN contributed to analysis and interpretation of computer tomography images. SE contributed to data analysis and writing. RS contributed to statistical analysis. VN contributed to statistical analysis. DMK contributed to data analysis and writing.
Corresponding author
Ethics declarations
Conflict of interest
The author declares no potential conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Peled, C., Novoa, R., El-Saied, S. et al. Computer tomography findings in necrotizing otitis externa based on the offending pathogens. Eur Arch Otorhinolaryngol 278, 4707–4713 (2021). https://doi.org/10.1007/s00405-020-06583-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-020-06583-7