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Predictive factors in treatment response of malignant external otitis

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the prevalence and impact of various predictive factors including diabetes control in malignant external otitis (MEO) treatment response.

Methods

In a cross-sectional study on MEO patients, we defined treatment response with three indices; ESR level decrease, hospitalization period, and systemic antifungal drug usage. The impact of diabetes control and other predictive factors on these indices have been evaluated.

Results

Overall, 164 patients with a mean age of 67.8 ± 9.7 years were included. Cranial nerve involvement was present in 56 patients. Nine patients had immunodeficiency. 19.5% of cases had leukocytosis. Diabetes mellitus was present in 156 patients, suffering for an average of 13.9 ± 8.6 years. The overall mean hemoglobin A1C (HbA1c) level was 8.3% (4.4–12.8%), and the mean fasting blood sugar was 146.4 mg/dl (63–292 mg/dl). 29.3% of patients had good diabetes control before admission (HbA1c < 7%), 54.9% had poor control (7% < HbA1c < 10%) and 15.9% had very poor glycemic control (HbA1c > 10%). The predictive role for the following factors were not statistically significant: age, gender, comorbidities, diabetes, diabetes management method used before and during hospitalization, diabetes duration, leukocytosis, immunodeficiency, fasting blood sugar level, HbA1c level, glycemic control index, and insulin amount. However, CRP level with a mean value of 34.3 mg/L showed a significant correlation with ESR decrease, hospitalization period, and antifungal drug usage.

Conclusion

CRP level could be used as a predictor for the hospitalization period, the need for systemic antifungal and ESR level decrease. It would be helpful to check the CRP level at the time of diagnosis to predict the hospitalization period and the necessity of systemic antifungal management to adjust the treatment strategy.

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Acknowledgements

This research was done as a medical graduation thesis in Amir Alam Hospital which is affiliated with Tehran University of Medical Sciences.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Otorhinolaryngology Research Center, Department of Otorhinolaryngology-Head and Neck Surgery, Amir Alam Hospital, Tehran University of Medical Sciences, North Saadi Ave, Tehran, 11457-65111, Iran

    Alireza Zonnour, Abolfazl Jamshidi, Sasan Dabiri, Ardavan Tajdini, Narges Karrabi & Nasrin Yazdani

  2. Department of Internal Medicine (Infectious Disease Division), Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Mehrdad Hasibi

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  1. Alireza Zonnour
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  2. Abolfazl Jamshidi
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  5. Ardavan Tajdini
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  7. Nasrin Yazdani
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Contributions

AZ contributed to conceptualization, methodology, investigation, writing—original draft, formal analysis, and data curation. AJ was involved in writing—review and editing, resources, and data curation. SD contributed to methodology, project administration, and formal analysis. MH contributed to resources and validation. AT performed validation. NK contributed to resources. NY did supervision.

Corresponding author

Correspondence to Nasrin Yazdani.

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Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethics approval

This study was approved by the Ethics Committee at Tehran University of Medical Sciences (IR.TUMS.MEDICINE.REC.1397.413). The clinical investigations were all conducted according to the principles expressed in the Declaration of Helsinki.

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Zonnour, A., Jamshidi, A., Dabiri, S. et al. Predictive factors in treatment response of malignant external otitis. Eur Arch Otorhinolaryngol 280, 159–166 (2023). https://doi.org/10.1007/s00405-022-07478-5

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