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Negative Prognostic Factors For Malignant External Otitis And The Effectiveness Of The Treatment

Year 2014, Volume: 39 Issue: 3, 525 - 531, 22.07.2014
https://doi.org/10.17826/cutf.96823

Abstract

Purpose: Malignant external otitis is a very rare and serious infection of temporal bone and surrounding tissues. This report aimed to determine negative prognostic factors, effectiveness of treatment and companing with literature. Material and Methods: Fourty-one patient"s files who were hospitalized in Cukurova University Medical Faculty Ear Nose and Throat department were examined retrospectively. Patient"s files, comorbidities, radiographic examination, microbiological culture results, treatment protocols, treatment and their responses were analyzed. Results: Patients were between 38 and 90 years old and median age was 63,24. Fourty of them were diabetic. Nine of 19 insulin users (47,4%) and 5 of oral antidiabetic users (23,8%) were found to be in negative prognostic group. There were 7 patients with facial paralysis and 3 of them died. There were bilateral diseases in 5 patients and 4 of them had recurrence after treatment. Eight patients had advenced radiological findings and 1 of them died (12,5%). And 6 of 8 patients who had serious infection of temporal bone assesed in negative prognostic group. Conclusion: Insulin dependent diabetes, bilateral disease, advenced infection and facial paralysis were considered to be negative prognostic factors. The success of treatment was considered to be dependent on control of diabetes, daily ear aspirations, and long term combined antibiotherapy. Early diagnosis and treatment is essential.

References

  • Babiatzki A, Sade J. Malignant external otitis. J Laryngol Otol. 1987;101:205-10.
  • Rubin J, Yu VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis and therapy. Am J Med. 1988;85:391-8.
  • Rubin J, Yu VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis, and therapy. Am J Med. 1988;85:391–8.
  • Keay DG, Murray JA. Malignant otitis externa due to staphylococcus infection. J Laryngol Otol. 1988;102:926–7.
  • Munoz A, Martinez-Chamorro E. Necrotizing external otitis caused by Aspergillus fumigatus: computed tomography and high resolution magnetic resonance imaging in an AIDS patient. J Laryngol Otol. 1998;112:98–102.
  • Bae WK, Lee KS, Park JW, Bae EH, Ma SK, Kim NH et al. A case of malignant otitis externa caused by Candida glabrata in a patient receiving haemodialysis. Scand J Infect Dis. 2007;39:370–2.
  • Chai FC, Auret K, Christiansen K, Yuen PW, Gardam D. Malignant otitis externa caused by Malassezia sympodialis. Head Neck. 2000;22:87–9.
  • Yang TH, Kuo ST, Young YH. Necrotizing external otitis in a patient caused by Klebsiella pneumoniae. Eur Arch Otorhinolaryngol. 2006;263:344–6.
  • Ress BD, Luntz M, Telischi FF, Balkany TJ, Whiteman ML. Necrotizing external otitis in patients with AIDS. Laryngoscope. 1997;107:456–60.
  • Coser PL, Stamm AE, Lobo RC, Pinto JA. Malignant external otitis in infants. Laryngoscope. 1980;90:312–
  • Chandler JR. Malignant external otitis. Laryngoscope. 1968;78:1257–94.
  • Eveleigh MO, Hall CE, Baldwin DL. Prognostic scoring in necrotising otitis externa.. J Laryngol Otol. 2009;123:1097-102.
  • Cunningham M and others: Necrotizing otitis externa due to Aspergillus in an immunocompetent patient, Arch Otolaryngol Head Neck Surg.1988;114:554-8.
  • Keay DG, Murray JA. Malignant otitis externa due to Staphylococcus infection, J Laryngol Otol. 1988;102:926-30.
  • Soldatı D, Mudry A, Monnier P. Necrotizing otitis externa caused by Staphylococcus epidermidis, Eur Arch Oto-Rhino-Laryngol. 1999;256:439-53.
  • Hariga I, Mardassi A, Belhaj Younes F, Ben Amor M, Zribi S, Ben Gamra O, Mbarek C, El Khedim A. Necrotizing otitis externa: 19 cases' report. Eur Arch Otorhinolaryngol. 2010;267:1193-8.
  • Chen YA, Chan KC, Chen CK, Wu CM. Differential diagnosis and treatments of necrotizing otitis externa: A report of 19 cases. Auris Nasus Larynx. 2011;38:666-70.
  • Grandis JR, Branstetter BF, Yu VL. The changing face of malignant external otitis: clinical, radiological and anatomic correlations. Lancet Infect Dis. 2004;4:34–9.
  • Bouccara D, Simon-Blancal V, Rodallec M, CynaGorse F, Mosnier I, Fantin B, Sterkers O. Ostéomyélite de la base du crâne d’origine otosinusienne: étude d’une série de cinq cas récents. Ann Otolaryngol Chir Cervicofac. 2007;24:25–32.
  • Rubin J, Yu VL Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis and therapy. Am J Med. 1988;85:391–98.
  • Amorosa L, Modugno GC, Pirodda A. Malignant external otitis: review and personal experience. Acta Otolaryngol Suppl. 1996;521:3–16.
  • Martel J, Duclos JY, Darrouzet V, Guyot M, Bébéar JP. Malignant or necrotizing otitis externa: experience in 22 cases.. Ann Otolaryngol Chir Cervicofac. 2000;117:291-4.
  • Yazışma Adresi / Address for Correspondence: Dr. Özgür Sürmelioğlu Çukurova Üniversitesi Tıp Fakültesi Kulak Burun Boğaz Anabilim Dalı Email:surmeli2004@yahoo.com.
  • G eliş tarihi/Received on: 26.01.2014
  • Kabul tarihi/Accepted on:03.03.2014

Malign Eksternal Otitli Hastalarda Prognozu Olumsuz Etkileyen Faktörlerin Ve Tedavi Etkinliğinin Araştırılması

Year 2014, Volume: 39 Issue: 3, 525 - 531, 22.07.2014
https://doi.org/10.17826/cutf.96823

Abstract

Amaç: Malign eksternal otit temporal kemiğin ve çevre dokuların ender görülen ciddi enfeksiyonudur. Bu çalışmada hastalığın prognozunu olumsuz etkileyen faktörlerin saptanması ve tedavi etkinliğinin değerlendirilmesi ve literatürle karşılaştırılması amaçlandı. Materyal ve Metod: Çukurova Üniversitesi Tıp Fakültesi Kulak Burun Boğaz Anabilim Dalı"nda Ocak 2002 ile Temmuz 2011 tarihleri arasında Malign External Otit tanısıyla yatırılıp tetkik ve tedavi edilen 41 hastanın dosyaları incelendi. Hastaların dosyaları, eşlik eden hastalıkları, radyolojik incelemeleri, mikrobiyolojik kültür sonuçları, tedavi protokolleri, tedaviye verdikleri cevaplar ve takipleri incelendi. Bulgular: Hastaların yaşları 38 ile 90 arasında değişmekte olup ortalama 63,24 olarak hesaplandı. Çalışmaya dahil edilen 41 hastadan 40"ında diabet mevcuttu. İnsulin kullanan 19 hastadan 9"u (%47,4) oral antidiyabetik kullanan hastaların ise 5"i (%23,8) kötü prognozlu hastalar grubuna dahildi. Bu çalışmada fasial paralizi bulunan 7 hastanın 3"ü kaybedilmiş olup mortalite oranı %42,9"dur. Bilateral tutulum olan 5 hastanın 4"ünde (%80) tedavi sonrası rekürrens gelişmesi üzerine tekrar kliniğimize yatırılarak tedavi uygulanmıştır. Yaygın radyolojik tutulum gösteren toplam 8 hastamızın 1 tanesi kaybedilmiş olup mortalite oranı %12,5 olarak bulunmuştur. Temporal kemikte yaygın enfeksiyon bulguları olan 8 hastadan 6"sı (%75) kötü prognozlu hastalar grubuna dahil olmuştur. Sonuç: İnsuline bağlı diabet, bilateral kulak tutulumu, yaygın enfeksiyon, fasial paralizinin prognozu olumsuz etkileyen faktörler olduğu düşünülmüştür. Tedavinin başarısı diabetin kontrolüne, günlük kulak pansumanına ve uzun süreli kombine antibiyoterapiye bağlıdır. Erken tanı ve tedavi şarttır.

References

  • Babiatzki A, Sade J. Malignant external otitis. J Laryngol Otol. 1987;101:205-10.
  • Rubin J, Yu VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis and therapy. Am J Med. 1988;85:391-8.
  • Rubin J, Yu VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis, and therapy. Am J Med. 1988;85:391–8.
  • Keay DG, Murray JA. Malignant otitis externa due to staphylococcus infection. J Laryngol Otol. 1988;102:926–7.
  • Munoz A, Martinez-Chamorro E. Necrotizing external otitis caused by Aspergillus fumigatus: computed tomography and high resolution magnetic resonance imaging in an AIDS patient. J Laryngol Otol. 1998;112:98–102.
  • Bae WK, Lee KS, Park JW, Bae EH, Ma SK, Kim NH et al. A case of malignant otitis externa caused by Candida glabrata in a patient receiving haemodialysis. Scand J Infect Dis. 2007;39:370–2.
  • Chai FC, Auret K, Christiansen K, Yuen PW, Gardam D. Malignant otitis externa caused by Malassezia sympodialis. Head Neck. 2000;22:87–9.
  • Yang TH, Kuo ST, Young YH. Necrotizing external otitis in a patient caused by Klebsiella pneumoniae. Eur Arch Otorhinolaryngol. 2006;263:344–6.
  • Ress BD, Luntz M, Telischi FF, Balkany TJ, Whiteman ML. Necrotizing external otitis in patients with AIDS. Laryngoscope. 1997;107:456–60.
  • Coser PL, Stamm AE, Lobo RC, Pinto JA. Malignant external otitis in infants. Laryngoscope. 1980;90:312–
  • Chandler JR. Malignant external otitis. Laryngoscope. 1968;78:1257–94.
  • Eveleigh MO, Hall CE, Baldwin DL. Prognostic scoring in necrotising otitis externa.. J Laryngol Otol. 2009;123:1097-102.
  • Cunningham M and others: Necrotizing otitis externa due to Aspergillus in an immunocompetent patient, Arch Otolaryngol Head Neck Surg.1988;114:554-8.
  • Keay DG, Murray JA. Malignant otitis externa due to Staphylococcus infection, J Laryngol Otol. 1988;102:926-30.
  • Soldatı D, Mudry A, Monnier P. Necrotizing otitis externa caused by Staphylococcus epidermidis, Eur Arch Oto-Rhino-Laryngol. 1999;256:439-53.
  • Hariga I, Mardassi A, Belhaj Younes F, Ben Amor M, Zribi S, Ben Gamra O, Mbarek C, El Khedim A. Necrotizing otitis externa: 19 cases' report. Eur Arch Otorhinolaryngol. 2010;267:1193-8.
  • Chen YA, Chan KC, Chen CK, Wu CM. Differential diagnosis and treatments of necrotizing otitis externa: A report of 19 cases. Auris Nasus Larynx. 2011;38:666-70.
  • Grandis JR, Branstetter BF, Yu VL. The changing face of malignant external otitis: clinical, radiological and anatomic correlations. Lancet Infect Dis. 2004;4:34–9.
  • Bouccara D, Simon-Blancal V, Rodallec M, CynaGorse F, Mosnier I, Fantin B, Sterkers O. Ostéomyélite de la base du crâne d’origine otosinusienne: étude d’une série de cinq cas récents. Ann Otolaryngol Chir Cervicofac. 2007;24:25–32.
  • Rubin J, Yu VL Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis and therapy. Am J Med. 1988;85:391–98.
  • Amorosa L, Modugno GC, Pirodda A. Malignant external otitis: review and personal experience. Acta Otolaryngol Suppl. 1996;521:3–16.
  • Martel J, Duclos JY, Darrouzet V, Guyot M, Bébéar JP. Malignant or necrotizing otitis externa: experience in 22 cases.. Ann Otolaryngol Chir Cervicofac. 2000;117:291-4.
  • Yazışma Adresi / Address for Correspondence: Dr. Özgür Sürmelioğlu Çukurova Üniversitesi Tıp Fakültesi Kulak Burun Boğaz Anabilim Dalı Email:surmeli2004@yahoo.com.
  • G eliş tarihi/Received on: 26.01.2014
  • Kabul tarihi/Accepted on:03.03.2014
There are 25 citations in total.

Details

Primary Language Turkish
Journal Section Research
Authors

Arzu Mammadov This is me

Fikret Çetik This is me

Özgür Sürmelioğlu This is me

Özgür Tarkan This is me

Süleyman Özdemir This is me

Ülkü Tuncer This is me

Publication Date July 22, 2014
Published in Issue Year 2014 Volume: 39 Issue: 3

Cite

MLA Mammadov, Arzu et al. “Malign Eksternal Otitli Hastalarda Prognozu Olumsuz Etkileyen Faktörlerin Ve Tedavi Etkinliğinin Araştırılması”. Cukurova Medical Journal, vol. 39, no. 3, 2014, pp. 525-31, doi:10.17826/cutf.96823.