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[Malignant external otitis. When and which imaging]
K Marsot-Dupuch1, A Tiyriboz, B Meyer
1Service de Radiologie, Hôpital Saint-Antoine, Paris.
Abstract:
Malignant external otitis (MEO) is a severe infection of the external auditory canal (EAC), most often caused by Pseudomonas aeruginosa, although a few cases are caused by an Aspergillus (4). Mortality remains high (20%) in spite of an early general antibiotic treatment. This infection of the soft tissue of the EAC causes cellulitis, chondritis and osteomyelitis, and there are risks of diffusion into the base of the skull. Our work is aimed at placing computed tomography and magnetic resonance imaging into the context of exploration of this infection, in relation to radionuclide scanning, owing to our experience with 10 patients. Imaging appreciates the anatomical extension of the infection beyond the EAC and towards the base of the skull and the infratemporal fossa, this being a key element for prognosis. It assesses the efficiency and duration of treatment, although the criteria of healing are still difficult to appreciate and late recurrence is frequent. Exceptionally, it is useful for diagnosis in some particular clinical forms.
Insights
Malignant external otitis (MEO), a severe Pseudomonas aeruginosa infection, has high mortality. Advanced imaging like CT and MRI are crucial for assessing MEO
Area of Science:
- Otolaryngology
- Infectious Diseases
- Radiology
Background:
- Malignant external otitis (MEO) is a severe external auditory canal infection, often caused by Pseudomonas aeruginosa.
- High mortality (20%) persists despite antibiotic treatment, with risks of skull base diffusion.
- MEO involves cellulitis, chondritis, and osteomyelitis of the external auditory canal soft tissues.
Purpose of the Study:
- To evaluate the role of computed tomography (CT), magnetic resonance imaging (MRI), and radionuclide scanning in exploring MEO.
- To correlate imaging findings with anatomical extension, prognosis, and treatment assessment in MEO patients.
Main Methods:
- Retrospective analysis of 10 patients with Malignant External Otitis.
- Utilized CT, MRI, and radionuclide scanning for anatomical assessment.
- Correlated imaging findings with clinical progression and treatment response.
Main Results:
- Imaging effectively delineates the anatomical extent of MEO beyond the ear canal towards the skull base and infratemporal fossa.
- Imaging is valuable for assessing treatment efficacy and duration, though healing criteria remain challenging.
- Late recurrences of MEO are frequent, and imaging plays a limited diagnostic role in specific clinical presentations.
Conclusions:
- CT, MRI, and radionuclide scanning are essential for evaluating the anatomical spread and guiding management of Malignant External Otitis.
- Imaging provides critical prognostic information and aids in monitoring treatment response for MEO.
- Despite imaging's utility, definitive healing criteria and frequent late recurrences pose ongoing challenges in MEO management.