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[Two cases of intractable malignant external otitis with skull base osteomyelitis alleviated by intraarterial

Hiroshi Yamazaki1, Yasushi Naito, Shogo Shinohara

  • 1Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe.

Nihon Jibiinkoka Gakkai Kaiho
|December 24, 2010
PubMed

Insights

Intraarterial antibiotic infusion (IA) effectively treats malignant external otitis (MEO), a severe ear infection. This method rapidly improved symptoms in patients with refractory MEO, offering a new treatment option.

Area of Science:

  • Otolaryngology
  • Infectious Diseases
  • Vascular Surgery

Background:

  • Malignant external otitis (MEO) is a severe infection of the ear canal, often seen in elderly patients with diabetes.
  • It can lead to life-threatening complications like skull base osteomyelitis (SBO), meningitis, and cranial nerve palsies.
  • Diabetic microangiopathy and Pseudomonas infection contribute to poor tissue vascularity, causing refractory infections.

Observation:

  • Two patients with intractable MEO, unresponsive to conventional treatments, were administered intraarterial antibiotic infusion (IA) via the external carotid artery.
  • IA therapy significantly increased antibiotic concentration within the infected tissues.
  • Patients showed rapid clinical improvement of MEO symptoms shortly after initiating IA.

Findings:

  • Intraarterial antibiotic infusion (IA) demonstrated effectiveness in treating refractory malignant external otitis (MEO).
  • IA therapy, followed by continued intravenous and oral antibiotics, led to dramatic improvement in MEO.
  • Minimal residual infection was noted at the skull base post-treatment.

Implications:

  • IA offers a promising therapeutic strategy for intractable MEO, particularly in patients with diabetic complications.
  • This approach may prevent severe complications associated with MEO and skull base osteomyelitis.
  • Targeted antibiotic delivery via IA can overcome challenges posed by poor vascularity in refractory infections.

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