Proposal for diagnostic and treatment criteria of necrotizing otitis externa
DOI:
https://doi.org/10.34631/sporl.324Keywords:
Necrotizing external otitis, Malignant external otitis, diagnostic criteriaAbstract
Necrotizing external otitis (NOE) is an infrequent and potentially fatal infection with origin in the external ear canal. Since there are no guidelines for this pathology in the literature, it is often observed a delay in its diagnosis and treatment. This study aims the proposal of specific diagnostic criteria and treatment orientations for NOE. We conducted a retrospective analysis of the NOE cases diagnosed between 2010 and 2013 in the ENT service of Egas Moniz Hospital. During the study period 9 patients were diagnosed with NOE (mean age: 74.8 ± 7.7 years). Based on our results and on data described in the literature, we propose major and minor criteria for the diagnosis of NOE and specific orientations for the treatment of this pathology. We believe that the use of the proposed criteria and orientations will allow a more timely diagnosis and a more effective treatment of this potentially fatal infection.
References
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 Dec;38(6):666-70
Rubin Grandis J, Branstetter BF 4th, Yu VL. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis. 2004 Jan;4(1):34-9
Patmore H, Jebreel A, Uppal S, Raine CH, et al. Skull base infection presenting with multiple lower cranial nerve palsies. Am J Otolaryngol. 2010 Sep-Oct;31(5):376-80
Bock K, Ovesen T. Optimised diagnosis and treatment of necrotizing external otitis is warranted. Dan Med Bull. 2011 Jul;58(7):A4292
Illing E, Olaleye O. Malignant otitis externa: a review of aetiology, presentation, investigations and current management strategies. WebmedCentral OTORHINOLARYNGOLOGY 2011;2(3):WMC001725
Hariga I, Mardassi A, Belhaj Younes F, Ben Amor M, et al. Necrotizing otitis externa: 19 cases’ report. Eur Arch Otorhinolaryngol. 2010 Aug;267(8):1193-8
Flint PW, Haughey BH, Lund VJ, Niparko JK, et al. Cummings Otorhinolaryngology - Head and Neck Surgery. 5ª Edição, Volume 1, Mosby Elsevier, 2010:pp1947-8
Rubin J, Yu VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis, and therapy. Am J Med. 1988 Sep;85(3):391-8
Escada PA, Capucho MC, Correia JP, Pacheco T, et al. Otite externa maligna micótica: abordagem diagnóstica e terapêutica de uma situação rara. Revista Portuguesa de Otorrinolaringologia e Cirurgia Cérvico-Facial. 1999;37(2):145-157
Sudhoff H, Rajagopal S, Mani N, Moumoulidis I, et al. Usefulness of CT scans in malignant external otitis: effective tool for the diagnosis, but of limited value in predicting outcome. Eur Arch Otorhinolaryngol. 2008 Jan;265(1):53-6
Kwon BJ, Han MH, Oh SH, Song JJ, et al. MRI findings and spreading patterns of necrotizing external otitis: is a poor outcome predictable? Clin Radiol. 2006 Jun;61(6):495-504
Grandis JR, Curtin HD, Yu VL. Necrotizing (malignant) external otitis: prospective comparison of CT and MR imaging in diagnosis and follow-up. Radiology. 1995 Aug;196(2):499-504
Carfrae MJ, Kesser BW. Malignant otitis externa. Otolaryngol Clin North Am. 2008 Jun;41(3):537-49
Stokkel MP, Boot CN, van Eck-Smit BL. SPECT gallium scintigraphy in malignant external otitis: initial staging and follow-up. Case reports. Laryngoscope. 1996 Mar;106(3 Pt 1):338-40
Jacobsen LM, Antonelli PJ. Errors in the diagnosis and management of necrotizing otitis externa. Otolaryngol Head Neck Surg. 2010 Oct;143(4):506-9
Jones ME, Karlowsky JA, Draghi DC, Thornsberry C, et al. Antibiotic susceptibility of bacteria most commonly isolated from bone related infections: the role of cephalosporins in antimicrobial therapy. Int J Antimicrob Agents. 2004 Mar;23(3):240-6
Phillips JS, Jones SE. Hyperbaric oxygen as an adjuvant tratment for malignant otitis externa. Cochrane Database Syst Rev. 2013 May 31;5:CD004617
