Mahdyoun p1, pulcini c, gahide i, raffaelli c, savoldelli c, castillo l, guevara n. In one recent study,1 otitis externa was found to be disabling enough to cause 36 percent of patients to interrupt their. Necrotizing otitis externa article about necrotizing. Extension to the deep soft tissues of the face and to the central nervous system determines the severity of this infection. Apr, 2020 lee je, song jj, oh sh, chang so, kim ch, lee jh. We are seeing an increase in this condition in elderly people with diabetes. Necrotizing otitis externa noe is a severe inflammatory process of the external ear and temporal bone. Necrotizing otitis externa is a potentially lifethreatening disease and needs early aggressive treatment to prevent longterm morbidity. Statistical analysis was made using computer software version 21. Pathology outlines necrotizing malignant external otitis.
Benign necrotizing otitis externa linkedin slideshare. Malignant otitis externa moe is a rare fatal inflammatory disease of the external auditory canal, temporal bone, and skull base 1. Necrotizing otitis externa, malignant external otitis, malignant otitis externa, osteitis of the skull base, malignant otitis externa due to pseudomonas aeruginosa, osteomyelitis of temporal bone. It is an osteomyelitis of the temporal bone and skull base, which takes its origin from the. Management algorithm for suspected necrotizing otitis externa. Over a period of 10 years 19972006, we treated 19 patients. Cooper t1, hildrew d2, mcafee js3, mccall aa1, branstetter bf 4th14, hirsch be1. Acute otitis media otitis externa can be secondary to otorrhoea from otitis media, particularly common in younger children, especially if they have had ventilation tubes grommets inserted in the tympanic membrane. Effective inexpensive management of necrotizing otitis externa is. Singlephoton emission computed tomography with low does computed tomography spectct images of the head.
Mahdyoun p, pulcini c, gahide i, raffaelli c, savoldelli c, castillo l, guevara n. It is most commonly caused by pseudomonas but is also less commonly caused by staphylococcus aureus and proteus mirabilis. Parisier sc, lucente fe, som pm, hirschman sz, arnold lm, roffman jd. An early clinical diagnosis confirmed by imaging and microbiology allows initiation of. Otitis externa is defined as the presence of inflammation in the external auditory canal, most commonly associated with discomfort, swelling and erythema of the canal with variable discharge. Antonelli key points computed tomography can make the presumptive diagnosis of necrotizing otitis externa when the disease is beyond its early stage and produces at least some bone erosion. Necrotizing otitis externa noe, also known as malignant otitis externa, is a severe invasive infection of the external auditory canal eac which can spread rapidly to involve the surrounding soft tissue, adjacent neck spaces and skull base. Necrotizing or malignant otitis externa in patients presenting with mild clinical findings can pose as a tip of the iceberg. Progression of acute bacterial otitis externa to necrotizing a.
May 01, 2016 objectives the authors present a case study of suspected necrotizing malignant otitis externa, confirmed with tc99mmdp bone scan and spectct. A tc 99m bone scan, a valuable test since results are positive in early cases of osteomyelitis of the temporal bone and base of skull, showed increased uptake in. Necrotizing external otitis malignant otitis externa is an uncommon form of external otitis that occurs mainly in elderly diabetics, being somewhat more likely and more severe when the diabetes is poorly controlled. Early necrotising otitis externa noe does not always show osseous destruction on ct imaging. Malignant external otitis meo is an infection that affects the external auditory. Patient with necrotizing otitis externa caused by stenotrophomonas maltophilia hautarzt 2003. Increasing reports of malignant external otitis in patients infected with the human immunodeficiency virus hiv implicate a.
Efficacy of hrct imaging vs spectct scans in the staging of. Malignant otitis externa is an aggressive infection rather than a malignancy, or cancer. A tc 99m bone scan, a valuable test since results are positive in early cases of osteomyelitis of the temporal bone and base of skull, showed increased uptake in all 18 patients. The disease is associated with serious complications with cranial nerve involvement and high mortality and morbidity rate 1. Necrotizing malignant otitis externa radiology key. It can also be caused by damage to the skin lining your outer ear canal. Methicillinresistant staphylococcus aureus mrsa has also been reported as a cause. Mar 01, 2001 otitis externa is an inflammatory process of the external auditory canal. Pseudomonas aeruginosa is the most frequently implicated organism. Spect imaging in evaluating extent of malignant external. Ct imaging is essential in establishing a diagnosis of malignant necrotizing otitis externa by revealing the extent of infection past the ear canal and extension to. Data were entered into spreadsheet software microsoft office excel 2008.
Methods the patient is an 87yearold male presented with a history of a chronic infection of the right ear with increasing severe otalgia for approximately 5 months despite multiple courses of. Imaging studies are important for determining the presence of. Otitis externa is most commonly caused by bacteria. Computed tomography or magnetic resonance imaging is useful in treatment surveillance.
Adams a, offiah c 2012 central skull base osteomyelitis as a complication of necrotizing otitis externa. Necrotizing otitis externa, also known as malignant otitis externa, is an aggressive and progressive infection of. A diagnosis of diffuse aoe requires rapid onset generally within 48 hours in the past 3 weeks of symptoms and signs of ear canal in. Otitis inflammation of the external, middle, or internal ear. This topic will focus it seems to us that you have your javascript disabled on your browser. Any diabetic or immunocompromised patient with persistent otalgia and otorrhea should be considered high risk for necrotizing otitis externa and should have a ct scan to aid diagnosis.
Anatomy and physiology consists of the auricle and eam skinlined apparatus approximately 2. A clinical diagnosis of necrotizing otitis externa can be confirmed with a raised erythrocyte sedimentation rate plus an abnormal computed tomography or magnetic resonance imaging scan 81,82. Otitis externa is often referred to as swimmers ear because repeated exposure to water can make the ear canal more vulnerable to inflammation. Computed tomography or magnetic resonance imaging is useful in treatment surveillance, based on the evaluation of soft tissue changes. Necrotizing malignant external otitis, an infection involving the temporal and adjacent bones, is a relatively rare complication of external otitis. Management of necrotizing otitis externa the journal of. An outer ear infection is an infection of the outer opening of the ear and the ear canal, which connects the outside of the ear to the eardrum. Patients present with severe otalgia, otorrhoea with or without facial palsy, or rarely, facial pain as a symptomatic feature. The term external otitis also known as otitis externa or swimmers ear refers to inflammation of the external auditory canal or auricle. Nuclear scanning in necrotizing progressive malignant external otitis. Imaging in the diagnosis and management of necrotizing. The usefulness of radionuclear scanning in the treatment of 18 patients with necrotizing progressive malignant external otitis is discussed. Prognostic value of extension patterns on followup magnetic resonance imaging in patients with necrotizing otitis externa. Benecke divided meo into necrotizing external otitis and skull base osteomyelitis.
Necrotizing otitis externa noe, also known as malignant otitis externa, is a severe invasive infection of the external auditory canal eac which can spread. Apr 27, 2020 necrotizing malignant external otitis. Malignant external otitis msd manual professional edition. Malignant necrotizing external otitis also termed malignant otitis externa is an invasive infection of the external auditory canal and skull base, which typ it seems to us that you have your javascript disabled on your browser. Malignant otitis externa moe, also called necrotizing otitis externa. Nuclear scanning in necrotizing progressive malignant. While the majority of cases are from bacterial infection, fungal, allergic. This canal goes from the outside of the ear to the eardrum. Study selection we included publications of all types including at least 6 cases. Single photon emission computed tomographycomputed.
Female patient with calcium oxalate crystal deposition in necrotizing otomycosis caused by aspergillus niger mod pathol 1993. Otitis externa, or swimmers ear, is an infection in the outer ear canal. Although there are dozens of publications dealing with this serious condition, there are still fundamental issues not fully understood in the diagnosis and treatment of noe. Malignant otitis externa moe is a rare fatal inflammatory disease of the. Surgical management of benign necrotizing otitis externa. Malignant necrotizing external otitis also termed malignant otitis externa is an invasive infection of the external auditory canal and skull base, which typically occurs in elderly patients with diabetes mellitus. An alternative name for malignant otitis externa is necrotizing external otitis. Imaging findings, complications, and challenges of diagnosis. Even less commonly, it can develop due to a severely compromised. This page includes the following topics and synonyms.
You can scratch or damage the skin lining when you put. Otitis externa is a condition that causes inflammation redness and swelling of the external ear canal, which is the tube between the outer ear and eardrum. The differential diagnosis of otitis externa includes. In terms of imaging, all 43 patients underwent ct 1010 patients in. Necrotizing otitis externa radiology reference article. Imaging in the diagnosis and management of necrotizing otitis externa. Malignant external otitis, also referred to as skull base osteomyelitis or necrotizing otitis externa, is typically a pseudomonas osteomyelitis of the temporal bone. May 03, 2017 malignant otitis externa is an aggressive infection rather than a malignancy, or cancer. The value of tc99mmdp bone scan and spectct in the. Computed tomography can make the presumptive diagnosis of necrotizing otitis externa when the disease is beyond its early stage and produces at least some bone erosion. Dec 01, 2017 necrotizing otitis externa is a potentially lifethreatening disease and needs early aggressive treatment to prevent longterm morbidity. Benign necrotizing otitis externa bnoe is a rare condition of unknown aetiology which is characterized by the formation of an avascular bony sequestrum of the tympanic plate. May 28, 2008 necrotizing otitis externa is a necrotizing osteomyelitis of the skull base that predominantly affects diabetic and immunocompromised patients.
Malignant otitis externa moe, also called necrotizing otitis externa, corresponds to osteomyelitis of the skull base, typically due to pseudomonas aeruginosa, initially arising in the external auditory canal eac. What are the physical findings of necrotizing otitis. May 14, 2017 necrotizing malignant otitis externa noe is a spreading necrotizing infection of the external auditory canal eac soft tissue that can produce an osteomyelitis of the entire skull base. Some patients however, develop a less controllable disease leading to. What are the physical findings of necrotizing otitis externa. Malignant otitis externa is an emerging problem in developing countries. Necrotizing otitis externa is a necrotizing osteomyelitis of the skull base that predominantly affects diabetic and immunocompromised patients. Conclusions this case illustrates the value oftriplephase bones scan and spectct imaging in the diagnosis of necrotizing malignant otitis externa and providing additional information guiding optimal clinical management of the patients. The term malignant external otitis was given by chandler. Patients at risk are those immunodepressed or having diabetes. Bernheim j, sade j 1989 histopathology of the soft parts in 50 patients with malignant external otitis. The terms invasive, necrotizing or malignant otitis externa are also used.
Otitis externa affects the skin of the auricle and external auditory meatus and proceeds with the formation of furuncles and eczema, as in other skin inflammations. Malignant external otitis merck manuals professional edition. We report a case of necrotizing otitis externa presenting. Necrotizing otitis externa is an uncommon but severe infectious disease of the external auditory canal. Imaging findings, complications, and challenges of diagnosis clinical radiology, vol. Acute bacterial otitis externa is common in swimmers. We excluded publications focused on cranial base osteomyelitis not originating from the external ear and publications limited to a specific population. Central skull base osteomyelitis as a complication of necrotizing otitis externa.