NECROTIZING (MALIGNANT) EXTERNAL OTITIS: A MODERN REVIEW OF DIAGNOSIS AND MANAGEMENT

Cover Page

Cite item

Full Text

Abstract

A review of modern principles of diagnosis and treatment of necrotic external otitis, which is a rare disease, is conducted, however, as it progresses and in the absence of adequate treatment, the treatment tends to spread to the bones of the skull base, which can lead to death. The risk group includes elderly patients with diabetes mellitus and patients with various immune disorders. The main infectious agents in the development of necrotic external otitis, the main of which is Pseudomonas aeruginosa, are considered. Mandatory and additional diagnostic criteria, which should be followed when establishing a diagnosis are presented. In therapeutic tactics, antibiotic therapy the main place. The fluoroquinolones and cephalosporins of the third generation are the drugs of choice, with scientists still discussing the duration of therapy, which most often is 6 weeks. The question of surgical treatment remains debatable, the indications and results of this method in patients with necrotizing external otitis are highlighted.

About the authors

Ekaterina V. Pchelenok

Russian Medical Academy of Continuous Professional Education

Email: epchelenok@yandex.ru
ассистент каф. оториноларингологии Moscow, Russia

Sergei Ya. Kosyakov

Russian Medical Academy of Continuous Professional Education

д-р мед. наук, проф., зав. каф. оториноларингологии Moscow, Russia

Alexander K. Vinnikov

Russian Medical Academy of Continuous Professional Education

канд. мед. наук, доц. каф. оториноларингологии Moscow, Russia

References

  1. Harida I, Mardassi A, Belhaj F et al. Necrotizing otitis externa: 19 cases’ report. Eur Arch Otorhinolaryngol 2010; 267 (8): 1193-8.
  2. Bhandary S, Karki P, Sinha B. Malignant otitis externa: a review. Pac Heal Dialog 2002; 9 (1): 64-7.
  3. Meltzer P, Kelemen G. Pyocutaneous osteomyelitis of the temporal bone, mandible, and zygoma. Laryngoscope 1959; 169: 1300-16.
  4. Chandler J. Malignant external otitis. Laryngoscope 1968; 78: 1257-94.
  5. Mani N et al. Cranial nerve involvement in malignant otitis externa: implications for clinical outcome. Laryngoscope 2007; 117: 907-10.
  6. Аринова С.П. Некротический отит у больной сахарным диабетом. Медицина и экология. 2012; 2 (63): 131-2. @@Arinova S.P Nekroticheskii otit u bol'noi sakharnym diabetom. Meditsina i ekologiia. 2012; 2 (63): 131-2 (in Russian).
  7. Chawdhary G. Liow N, Democratis J et al. Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistics trends. J Laryngol Otol 2015; 129 (6): 600-3.
  8. Bovo R, Benatti A, Ciorba A et al. Pseudomonas and Aspergillus interaction in malignant external otitis: risk of treatment failure. Acta Otorhi nol aryngol Ital 2012; 32 (6): 416-9.
  9. Бобров В.М. Некротический (злокачественный) наружный отит. Вестн. отоларингологии. 2011; 3: 71-2. @@Bobrov V.M. Nekroticheskii (zlokachestvennyi) naruzhnyi otit. Vestn. otolaringologii. 2011; 3: 71-2 (in Russian).
  10. Sobie S, Brodsky L, Stanievich J. Necrotizing external otitis in children: report of two cases and review of the literature. Laryngoscope 1987; 97 (5): 598-601.
  11. Carfrae M, Kesser B. Malignant otitis externa. Otolaryngol Clin North Am 2008; 41 (3): 537-49.
  12. Lee SK, Lee SA, Seon SW et al. Analysis of Prognostic Factors in Malignant External Otitis. Clin Exp Otorhinolaryngol 2017; 10 (3): 228-35.
  13. Phillips J, Jones S. Cochrane Database Syst Rev 2005: 18: CD004617.
  14. Hobson CE, Moy JD, Byers KE. Malignant Otitis Externa: Evolving Pathogens and Implications for Diagnosis and Treatment. Otolaryngol Head Neck Surg 2014; 151 (1): 112-6.
  15. Wyatt RJ, Alexander RC, Egan MF et al. Schizophrenia, just the facts. What do we know, how well do we know it? Schizophr Res 1988; 1: 3-18.
  16. Rosenfeld R, Schwartz SR, Cannon SR et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg 2014; 150 (1l): 1-24.
  17. Mahdyoun P, Pulcini C, Gahide I et al. Necrotizing Otitis Externa. Otol Neurotol 2013; 34 (4): 620-9.
  18. Chen J, Yeh CF Shiao AS et al. Temporal bone osteomyelitis: the relationship with malignant otitis externa, the diagnostic dilemma, and changing trends. Sci World J 2014; 591714.
  19. Bovo R, Martini A, Agnoletto M et al. Pseudomonas and Aspergillus interaction in malignant external otitis: risk of treatment failure. Acta Otorhinolaryngol Ital 2012; 32 (6): 416-9.
  20. Hamzany Y, Soudry E, Preis M. Fungal malignant external otitis. J Infect 2011; 62: 226-33.
  21. Rubin Grandis J, Branstetter Bf, Yu V. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis 2004; 4 (1): 34-9.
  22. Никифорова Г.Н., Свистушкин В.М., Шевчик Е.А., Золотова А.В. Злокачественный наружный отит: современные принципы диагностики и лечения. Вестн. отоларингологии. 2017; 82 (1): 11-4. ИНФОРМАЦИЯ ОБ АВТОРАХ / INFORMATION ABOUT THE AUTHORS @@Nikiforova G.N., Svistushkin V.M., Shevchik E.A., Zolotova A.V. Zlokachestvennyi naruzhnyi otit: sovremennye printsipy diagnostiki i lecheniia. Vestn. otolaringologii. 2017; 82 (1): 11-4 (in Russian).
  23. Geerlings S, Hoepelman A. Immune dysfunction in patients with diabetes mellitus. Immunol Med Microbiol 1999; 26 (3): 259-65.
  24. Крюков А.И., Кунельская Н.Л., Кунельская В.Я. Отомикоз: современный взгляд на этиологию и лечение. Вестн.отоларингологии. 2018;83 (1): 48-51. [Kriukov A.I., Kunel'skaia N.L., Kunel'skaia V. Ia. Otomikoz: sovremennyi vzgliad na etiologiiu i lechenie. Vestn. otolaringologii. 2018; 83 (1): 48-51 (in Russian).]
  25. Ress B, Luntz M, Telischi FF et al. Necrotizing External Otitis in patients with Aids. Laryngoscope 1997; 107 (4): 65-7.
  26. Carfrae M, Kesser B. Malignant otitis externa. Otolaryngol Clin North Am 2008; 41 (3): 537-49.
  27. Rowlands R, Lekakis G, Hinton A. Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy. J Laryngol Otol 2002; 116 (7): 556-8.
  28. Peleg U, Perez D, Raveh D et al. Stratification for malignant external otitis. Otolaryngol Head Neck Surg 2007; 137 (2): 301-5.
  29. Cohen D, Friedman P The diagnostic criteria of malignant external otitis. J Laryngol Otol 1987; 101 (3): 216-21.
  30. Joshua B, Sulkes J, Raveh E et al. Predicting outcome of malignant external otitis. Otol Neurotol 2008; 29 (3): 339-43.
  31. Sudhoff H, Rajagopal S, Mani N 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; 265 (1): 53-6.
  32. Okpala N, Siraj QH, Nilssen E et al. Radiological and radionuclide investigation of malignant otitis externa. J Laryngol Otol 2005; 119 (1): 71-5.
  33. Slattery W, Brackmann D. Skull base osteomyelitis: malignant otitis externa. Otolaryngol Clin North Am 1996; 29 (5): 795-806.
  34. Grandis J, Branstetter B, Yu V. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis 2004; 4 (1): 34-9.
  35. Bhat V, Aziz A, Bhandary SK et al. Malignant Otitis Externa - A Retrospective Study of 15 Patients Treated in a Tertiary Healthcare Center. J Int Adv Otol 2015; 11 (1): 72-6.
  36. Glikson E, Sagiv D, Wolf M et al. Necrotizing otitis externa: diagnosis, treatment, and outcome in a case series. Diagn Microbiol Infect Dis 2017; 87 (1): 74-8.
  37. Chawdhary G, Pankhania M, Douglas S et al. Current management of necrotising otitis externa in the UK: survey of 221 UK otolaryngologists. Acta Otolaryngol 2017; 137 (8): 818-22.
  38. Pulcini C, Mahdyoun P, Cua E et al. Antibiotic therapy in necrotising external otitis: case series of 32 patients and review of the literature. Eur J Clin Microbiol Infect Dis 2012; 31 (12): 3287-94.
  39. Mahdyoun P, Pulcini C, Gahide I et al. Necrotizing otitis externa: a systematic review. Otol Neurotol 2013; 34 (4): 620-9.
  40. Jang C, Park S. Emergence of ciprofloxacin-resistant Pseudomonas in chronic suppurative otitis media. Clin Otolaryngol 2004; 29 (4): 321-3.
  41. Jones M, Karlowsky JA, Draghi DC 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; 23 (3): 240-6.
  42. Mardassi A, Turki S, Lahiani R et al. Is there a real benefit of hyperbaric oxygenotherapy in the treatment of necrotizing otitis externa? Tunis Med 2016; 94 (12): 863.
  43. Orioli L, Boute C, Eloy P et al. Central skull base osteomyelitis: a rare but life-threatening disease. Acta Clin Belg 2015; 70 (4): 291-4.
  44. Stodulski D, Kowalska B, Stankiewicz C. Otogenic skull base osteomyelitis caused by invasive fungal infection: case report and literature review. Eur Arch Otorhinolaryngol 2006; 263 (12): 1070-6.
  45. Hamzany Y, Soudry E, Preis M. Fungal malignant external otitis. J Infect 2011; 62 (3): 226-31.
  46. Heiden C. Malignant otitis externa: experience with hyperbaric oxygen therapy. Diving Hyperb Med 2010; 40 (4): 182.
  47. Bolton L. Hyperbaric Oxygen Therapy Effects on Chronic Wounds. Wounds 2015; 27 (12): 354-5.
  48. Narozny W, Kuczkowski J, Stankiewicz C et al. Value of hyperbaric oxygen in bacterial and fungal malignant external otitis treatment. Eur Arch Otorhinolaryngol 2006; 263 (7): 680-4.
  49. Camporesi E. Side effects of hyperbaric oxygen therapy. Undersea Hyperb Med 2014; 41 (3): 253-7.
  50. Illing E, Zolotar M, Ross E et al. Malignant otitis externa with skull base osteomyelitis. J Surg Case Rep 2011; 5:6.
  51. Sander R. Otitis externa: a practical guide to treatment and prevention. Am Fam Physician 2001; 63 (5): 941-2.
  52. Foden N, Burgess C, Damato S et al. Concurrent necrotizing otitis externa and adenocarcinoma of the temporal bone: a diagnostic challenge. BMJ Case Rep 2013: 6.
  53. Soudry E, Joshua BZ, Sulkes J et al. Characteristics and prognosis of malignant external otitis with facial paralysis. Arch Otolaryngol Head Neck Surg 2007; 133 (10): 1002-4.
  54. Singh J, Bhardwaj B. The Role of Surgical Debridement in Cases of Refractory Malignant Otitis Externa. Indian J Otolaryngol Head Neck Surg 2018; 70 (4): 549-54.
  55. Hollis S, Evans K. Management of malignant (necrotising) otitis externa. J Laryngol Otol 2011; 125 (12): 1212-7.

Copyright (c) 2020 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies