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Malignant external otitis: analysis of severe cases.

Ethan Soudry1, Yaniv Hamzany, Michal Preis

  • 1Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tiqwa, Israel.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|April 16, 2011
PubMed
Summary
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Severe malignant external otitis (MEO) can be aggressive and fatal in a significant subset of patients. Early identification of risk factors like cranial nerve paralysis and CT findings is crucial for improved outcomes.

Area of Science:

  • Otolaryngology
  • Infectious Diseases
  • Radiology

Background:

  • Malignant external otitis (MEO) is a severe infection of the external auditory canal.
  • Type 1 MEO requires comprehensive evaluation of prognostic factors.

Purpose of the Study:

  • To investigate the impact of clinical, laboratory, and imaging parameters on the disease course and survival in severe MEO patients.
  • To identify early indicators of persistent or aggressive MEO.

Main Methods:

  • A retrospective case series with chart review of 57 patients hospitalized with severe MEO.
  • Data collected between 1990 and 2008 at a tertiary university-affiliated medical center.
  • Analysis of clinical, laboratory, imaging findings, and survival rates.

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Main Results:

  • 20% of patients experienced persistent/aggressive MEO, with 45% mortality in this subgroup.
  • Prognostic factors for aggressive disease included facial nerve paralysis, bilateral involvement, and CT findings (TMJ destruction, infratemporal fossa/nasopharyngeal involvement).
  • Fungal cultures were positive in 5 patients; 5-year survival was 55% for short-term disease vs. 40% for aggressive disease (P=.086), and significantly lower in patients over 70 (44% vs. 75%, P=.029).

Conclusions:

  • A subset of severe MEO patients presents with aggressive, high-mortality disease requiring early identification.
  • Bilateral disease, cranial nerve paralysis, and specific CT findings are key indicators of poor prognosis.
  • Routine imaging for disease progression and prompt identification/treatment of fungal infections are recommended.