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American Journal of Otolaryngology 2021Malignant otitis externa is a progressive infection of the external auditory canal and skull base. Pseudomonas aeruginosa is the most isolated microorganism and it... (Review)
Review
Malignant otitis externa is a progressive infection of the external auditory canal and skull base. Pseudomonas aeruginosa is the most isolated microorganism and it affects mostly to diabetic, elderly, and immunocompromised individuals. Non-resolving otalgia and chronic otorrhea are the clinical manifestations presented. Facial nerve palsy is a common and well recognized complication. (Computed tomography) CT scan is useful for initial assessment, Technetium-99m is highly sensitive and is part of the protocol for diagnosis. Treatment should be individualized, with multidisciplinary cooperation among specialties. Management involves systemic antipseudomonal antibiotics and monitoring with radiologic techniques, it also involves the strict control of diabetes. It is essential to follow up the patients for at least a year post-treatment. In refractory malignant otitis externa and affection of facial nerve, surgical management is recommended. We reviewed the most recent studies on epidemiology, clinical manifestations, diagnosis, and treatment to provide an update on Malignant Otitis Externa that can offer an overview for clinical practice and future research.
Topics: Aged; Anti-Bacterial Agents; Diabetes Mellitus; Female; Follow-Up Studies; Humans; Immunocompromised Host; Male; Otitis Externa; Otologic Surgical Procedures; Pseudomonas Infections; Pseudomonas aeruginosa; Severity of Illness Index; Skull Base; Tomography, X-Ray Computed
PubMed: 33429178
DOI: 10.1016/j.amjoto.2020.102894 -
Deutsches Arzteblatt International Mar 2019Otitis externa has a lifetime prevalence of 10% and can arise in acute, chronic, and necrotizing forms. (Review)
Review
BACKGROUND
Otitis externa has a lifetime prevalence of 10% and can arise in acute, chronic, and necrotizing forms.
METHODS
This review is based on publications retrieved by a selective search of the pertinent literature.
RESULTS
The treatment of acute otitis media consists of anal- gesia, cleansing of the external auditory canal, and the appli- cation of antiseptic and antimicrobial agents. Local antibiotic and corticosteroid preparations have been found useful, but there have been no large-scale randomized controlled trials of their use. Topical antimicrobial treatments lead to a higher cure rate than placebo, and corticosteroid preparations lessen swelling, erythema, and secretions. Oral antibiotics are indi- cated if the infection has spread beyond the ear canal or in patients with poorly controlled diabetes mellitus or immuno- suppression. Chronic otitis externa is often due to an under- lying skin disease. Malignant otitis externa, a destructive infection of the external auditory canal in which there is also osteomyelitis of the petrous bone, arises mainly in elderly diabetic or immunosuppressed patients and can be life- threatening.
CONCLUSION
With correct assessment of the different types of otitis externa, rapidly effective targeted treatment can be initi- ated, so that complications will be avoided and fewer cases will progress to chronic disease.
Topics: Administration, Topical; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chronic Disease; Humans; Otitis Externa; Randomized Controlled Trials as Topic
PubMed: 31064650
DOI: 10.3238/arztebl.2019.0224 -
American Family Physician Feb 2023Acute otitis externa is an inflammatory condition that affects the external ear canal. It is usually of rapid onset and is generally caused by bacterial infection. The... (Review)
Review
Acute otitis externa is an inflammatory condition that affects the external ear canal. It is usually of rapid onset and is generally caused by bacterial infection. The primary bacterial infections are Pseudomonas aeruginosa and Staphylococcus aureus. Acute otitis externa presents with pain (otalgia), redness, and swelling of the canal. It is more common in children and young adults. Tenderness on movement of the pinna or tragus is the classic finding. Analgesics and topical antibiotics are the mainstays of therapy. Topical medications include acetic acid 2%, aminoglycosides, polymyxin B, and quinolones with and without corticosteroids. There is no evidence that any one preparation is clinically superior to another, and the choice of treatment is based on factors such as cost, whether the tympanic membrane is intact, and patient adherence. Oral antibiotics are indicated only if evidence of cellulitis occurs outside of the ear canal or if associated conditions such as immunocompromise, diabetes mellitus, or conditions that would not allow for the use of topical treatment are found. Duration of topical treatment is usually seven to 10 days. Keys to prevention include avoiding injury to the ear canal and keeping it free of water.
Topics: Child; Humans; Young Adult; Acetic Acid; Acute Disease; Analgesics; Anti-Bacterial Agents; Ear Canal; Otitis Externa
PubMed: 36791445
DOI: No ID Found -
The Canadian Veterinary Journal = La... Jan 2019
Review
Topics: Animals; Diagnosis, Differential; Dog Diseases; Dogs; Microbial Sensitivity Tests; Otitis Externa
PubMed: 30651659
DOI: No ID Found -
Journal of the American Veterinary... Jun 2023Recurrent otitis externa is a common problem in dogs. Topical treatment for each flare is successful in the short term, but repeated cycles of inflammation and infection...
Recurrent otitis externa is a common problem in dogs. Topical treatment for each flare is successful in the short term, but repeated cycles of inflammation and infection lead to chronic inflammatory changes, pain and aversion, and antimicrobial resistance. These make the flares more frequent and harder to control. Eventually, the changes become irreversible and require a total ear canal ablation/lateral bulla osteotomy or ablative laser surgery. Most ear canal surgery is avoidable if recurrent otitis is properly managed at an earlier stage. This requires a different mindset and approach to these cases, taking advantage of recent research and clinical findings. Most importantly, clinicians must appreciate that all recurrent ear infections in dogs are secondary. To achieve a good long-term outcome, it is essential that all the underlying factors in each case are diagnosed and managed using the primary, secondary, predisposing, and perpetuating framework. This means that the primary condition must be diagnosed and managed, the secondary infection treated, predisposing risks identified and corrected, and the perpetuating factors reversed. Treatment is in 2 phases: induction to get the ears in remission and then long-term maintenance therapy to prevent relapses. Treatment should be appropriate to each dog but will typically involve ear cleaning, topical antimicrobial therapy, and topical or systemic glucocorticoids. Novel treatments for infection and inflammation will offer additional options in the future. Understanding the triggers for recurrent otitis in dogs will help clinicians plan effective management regimens that will make a huge difference to the quality of life of their patients and their owners.
Topics: Dogs; Animals; Otitis Externa; Quality of Life; Dog Diseases; Neoplasm Recurrence, Local; Ear Canal; Inflammation
PubMed: 37019436
DOI: 10.2460/javma.23.01.0002 -
BMJ Clinical Evidence Jun 2015Otitis externa is thought to affect 10% of people at some stage, and can present in acute, chronic, or necrotising forms. Otitis externa may be associated with eczema of... (Review)
Review
INTRODUCTION
Otitis externa is thought to affect 10% of people at some stage, and can present in acute, chronic, or necrotising forms. Otitis externa may be associated with eczema of the ear canal, and is more common in swimmers, in humid environments, in people with narrow ear canals, in hearing-aid users, and after mechanical trauma.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of empirical treatments for otitis externa? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review).
RESULTS
Nine studies were included. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: oral antibiotics, specialist aural toilet, topical acetic acid, topical aluminium acetate, topical antibacterials, topical antifungals, topical corticosteroids, and combinations of these agents.
Topics: Acetic Acid; Anti-Bacterial Agents; Glucocorticoids; Humans; Otitis Externa; Therapeutic Irrigation; Treatment Outcome
PubMed: 26074134
DOI: No ID Found -
BMJ (Clinical Research Ed.) Mar 2021
Topics: Administration, Topical; Adrenal Cortex Hormones; Anti-Bacterial Agents; Hearing Loss; Humans; Male; Middle Aged; Otitis Externa; Otoscopy; Pain; Pseudomonas Infections; Risk Factors; Staphylococcal Infections
PubMed: 33789841
DOI: 10.1136/bmj.n714 -
MMW Fortschritte Der Medizin Jun 2019
Review
Topics: Anti-Bacterial Agents; Humans; Otitis Externa
PubMed: 31230310
DOI: 10.1007/s15006-019-0656-8 -
Journal of Patient-centered Research... 2017Fungal infections as a result of freshwater exposure or trauma are fortunately rare. Etiologic agents are varied, but commonly include filamentous fungi and . This... (Review)
Review
Fungal infections as a result of freshwater exposure or trauma are fortunately rare. Etiologic agents are varied, but commonly include filamentous fungi and . This narrative review describes various sources of potential freshwater fungal exposure and the diseases that may result, including fungal keratitis, acute otitis externa and tinea pedis, as well as rare deep soft tissue or bone infections and pulmonary or central nervous system infections following traumatic freshwater exposure during natural disasters or near-drowning episodes. Fungal etiology should be suspected in appropriate scenarios when bacterial cultures or molecular tests are normal or when the infection worsens or fails to resolve with appropriate antibacterial therapy.
PubMed: 31413968
DOI: 10.17294/2330-0698.1262