Malignant external otitis: Factors predicting patient outcomes

AbstracT Objective Malignant external otitis (MEO) is an aggressive infection, primarily affecting elderly diabetic patients. It begins in the external ear canal and spreads to adjacent structures. This study investigated the clinical characteristics of patients diagnosed and treated for MEO and ana...

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Bibliographic Details
Published in:American journal of otolaryngology 2016-09, Vol.37 (5), p.425-430
Main Authors: Stern Shavit, Sagit, MD, Soudry, Ethan, MD, Hamzany, Yaniv, MD, Nageris, Ben, MD
Format: Article
Language:English
Subjects:
Acquisitions & mergers
Age
Aged
Aged, 80 and over
Antibiotics
Biopsy
Diabetes
Diabetes Complications - complications
Edema
Female
Humans
Infections
Inflammation
Male
Medical imaging
Medical prognosis
Methods
Middle Aged
Mortality
Neurological disorders
Otitis Externa - diagnosis
Otitis Externa - epidemiology
Otitis Externa - microbiology
Otolaryngology
Patients
Prognosis
Retrospective Studies
Risk Factors
Surgery
Survival Rate
Variables
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Summary:AbstracT Objective Malignant external otitis (MEO) is an aggressive infection, primarily affecting elderly diabetic patients. It begins in the external ear canal and spreads to adjacent structures. This study investigated the clinical characteristics of patients diagnosed and treated for MEO and analyzed factors affecting patient outcomes. Study design Historical cohort. Setting Tertiary medical center. Methods Medical records of all patients diagnosed and treated for MEO from 1990 to 2013, were retrospectively reviewed. Clinical features, laboratory, imaging and outcomes were analyzed. Results 88 patients were included, mean age was 73 ± 11.5 years, 61 (69%) were male. Of these, 75% had diabetes. Mean follow-up was 60 months. The most common presenting symptoms were otalgia (89%), external ear canal edema (86%) and otorrhea (84%). Pseudomonas aeruginosa was isolated in 61% of ear cultures. All patients were treated with antibiotics, 22% had surgery and 8% hyperbaric oxygen. Overall survival rate was 38% in 5 years, with disease specific mortality 14%. DM, facial nerve palsy, positive CT scan and age above 70 were found to correlate and predict disease-specific mortality. Conclusions MEO carries a grave prognosis. The presence of two or more of the following features, DM, facial nerve palsy, positive CT scan and age above 70, predicts poor outcome, and highlights the need for prolonged, vigorous treatment.
ISSN:0196-0709
1532-818X
DOI:10.1016/j.amjoto.2016.04.005