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The Journal of Laryngology and Otology Jun 2020Necrotising otitis externa is a progressive infection of the external auditory canal which extends to affect the temporal bone and adjacent structures. Progression of... (Review)
Review
BACKGROUND
Necrotising otitis externa is a progressive infection of the external auditory canal which extends to affect the temporal bone and adjacent structures. Progression of the disease process can result in serious sequelae, including cranial nerve palsies and death. There is currently no formal published treatment guideline.
OBJECTIVE
This study aimed to integrate current evidence and data from our own retrospective case series in order to develop a guideline to optimise necrotising otitis externa patient management.
METHODS
A retrospective review of necrotising otitis externa cases within NHS Lothian, Scotland, between 2013 and 2018, was performed, along with a PubMed review.
RESULTS
Prevalent presenting signs, symptoms and patient demographic data were established. Furthermore, features of cases associated with adverse outcomes were defined. A key feature of the guideline is defining at-risk patients with initial intensive treatment. Investigations and outcomes are assessed and treatment adjusted appropriately.
CONCLUSION
This multi-departmental approach has facilitated the development of a succinct, systematic guideline for the management of necrotising otitis externa. Initial patient outcomes appear promising.
Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Ciprofloxacin; Cranial Nerve Diseases; Disease Progression; Ear Canal; Humans; Necrosis; Otitis Externa; Outcome Assessment, Health Care; Patient Care Management; Practice Guidelines as Topic; Prevalence; Pseudomonas Infections; Pseudomonas aeruginosa; Retrospective Studies; Scotland; Staphylococcal Infections; Staphylococcus aureus; Temporal Bone
PubMed: 32498757
DOI: 10.1017/S0022215120001061 -
Indian Journal of Otolaryngology and... Dec 2023Diabetes mellitus is one of the risk factors for malignant otitis externa. There are very few studies on the disease in Africa and there is a need to pool the prior...
Diabetes mellitus is one of the risk factors for malignant otitis externa. There are very few studies on the disease in Africa and there is a need to pool the prior studies to highlight the characteristics of the disease. The study type is a systematic review and the PRISMA guidelines were followed. Using the appropriate terms, relevant medical databases were systematically searched. Thirty-two studies met the eligibility criteria with a total sample size of 848, who were mainly elderly. Diabetes mellitus was present in 94% of the participants. Average duration of diabetes diagnosis in the participants was 12.4 years. The pooled HbA1c was 9.8%. The most common symptoms were otalgia (96.1%), otorrhoea (75.8%) and hearing loss (56.1%). was the most common isolate (72%). Fluoroquinolones and the 3rd-generation cephalosporins were the preferred antibiotics. The pooled cure rate from antimicrobial usage was 76.2%. In addition to medications, 24.6% of the affected individuals required debridement. About 1.6% of the participants died from malignant otitis externa. Malignant otitis externa is associated with poorly controlled diabetes. Pseudomonas is the most common cause and a significant proportion gets cured with prolonged antibiotherapy.
PubMed: 37974885
DOI: 10.1007/s12070-023-03939-3 -
Vestnik Otorinolaringologii 2017The objective of the present study was to elucidate the specific features of the clinical course of malignant externa otitis in the context of the present-day concepts.... (Review)
Review
The objective of the present study was to elucidate the specific features of the clinical course of malignant externa otitis in the context of the present-day concepts. A total of 5 patients presenting with the confirmed diagnosis of malignant external otitis were available for the examination. The analysis of the clinical observations provided the basis for the characteristic of pathogenesis of this condition, diagnostic principles, and treatment modalities for the management of the pathology in question. It is concluded that the patients suffering from malignant externa otitis must remain under medical care and observation during a long period and the strategy for the treatment of each concrete patient should be chosen on an individual basis taking into consideration the presence of concomitant pathologies and their adequate therapy.
Topics: Humans; Otitis Externa
PubMed: 28252582
DOI: 10.17116/otorino201782111-14 -
Vestnik Otorinolaringologii 2022Otitis externa is a common disease. The article discusses the anatomical and physiological features of the structure of the outer ear, the epidemiology of otitis...
Otitis externa is a common disease. The article discusses the anatomical and physiological features of the structure of the outer ear, the epidemiology of otitis externa. Acute inflammation is characterized by the presence of significant microflora, and most often it is preceded by the impact of various physical factors. With chronic inflammation, more changes from the skin are recorded, while the microflora is not always isolated. The authors consider the problem of chronic inflammation of the outer ear. They provide their own data on the etiology of inflammation. Particular attention is paid to local treatment, including their own experience of using the combined drug Candiderm. As a result of the treatment, the skin changes of the external auditory canal were completely resolved in all patients by day 28, the itching in the ears completely stopped after 10-14 days of therapy. Stable remission was achieved in 89% of patients.
Topics: Humans; Otitis Externa; Ear Canal; Inflammation
PubMed: 36580512
DOI: 10.17116/otorino20228706167 -
Emergency Medicine Practice Apr 2024Though the vast majority of conditions associated with otalgia are not life-threatening, there are nuances and controversies in the diagnosis and management of even the...
Though the vast majority of conditions associated with otalgia are not life-threatening, there are nuances and controversies in the diagnosis and management of even the most common diseases, such as acute otitis media and otitis externa. For more severe disease processes, such as necrotizing otitis externa, acute mastoiditis, and perichondritis, early recognition and timely management are paramount in reducing morbidity and mortality. A systematic approach to the evaluation of these patients is key to establishing an accurate diagnosis, identifying patients who are at high risk for dangerous etiologies or complications, and providing optimal patient care. This issue summarizes the most recent guidelines and presents a systematic, evidence-based approach to the emergency department evaluation and management of patients with otalgia.
Topics: Humans; Earache; Otitis Externa; Otitis Media; Emergency Service, Hospital; Acute Disease
PubMed: 38507217
DOI: No ID Found -
Drugs Apr 2015Finafloxacin is a fluoroquinolone antimicrobial agent that exhibits optimum efficacy in slightly acidic environments. It is being developed by MerLion Pharmaceuticals to... (Review)
Review
Finafloxacin is a fluoroquinolone antimicrobial agent that exhibits optimum efficacy in slightly acidic environments. It is being developed by MerLion Pharmaceuticals to treat serious bacterial infections associated with an acidic environment, including urinary tract infections and Helicobacter pylori infections. An otic suspension of finafloxacin (Xtoro™), developed by Alcon (a division of Novartis), was recently approved in the USA for the treatment of acute otitis externa, and a Common Technical Document for this indication was also filed in Canada. Oral and/or intravenous formulations are in phase I and II evaluation in uncomplicated urinary tract infections (Germany and Singapore), complicated urinary tract infections and pyelonephritis (Germany and Poland) and H. pylori infection (Germany). This article summarizes the milestones in the development of finafloxacin leading to this first approval for otitis externa.
Topics: Animals; Anti-Bacterial Agents; Drug Approval; Fluoroquinolones; Helicobacter pylori; Humans; Internationality; Microbial Sensitivity Tests; Otitis Externa; Urinary Tract Infections
PubMed: 25808831
DOI: 10.1007/s40265-015-0384-z -
Family Practice Sep 2022Referrals for otitis externa (OE) have dramatically increased but the reasons for this remain unclear. We aim to characterize management of patients both pre- and...
INTRODUCTION
Referrals for otitis externa (OE) have dramatically increased but the reasons for this remain unclear. We aim to characterize management of patients both pre- and post-referral to identify areas of improvement at the primary-secondary care interface.
METHODS
Questionnaire study from consultant-led research clinic specifically set up to prospectively analyse OE referrals at a tertiary referral centre for Otolaryngology.
RESULTS
Sixty-two patients were included; 63% female, median age 57 years. One was excluded (clinically not OE). Most patients had multiple primary care visits before referral (average 4 GP; 2 practice nurse). Sixty per cent had received oral antibiotics (16% multiple classes). Eighteen per cent had never had ear drops. Thirty-nine per cent were not advised to keep ears dry. Twenty-one per cent had dermatitis; 13% contact allergy, 30% systemic allergy, 5% diabetes. Less than 10% had narrow canals. Thirty-six per cent had active discharge but <7% needed a wick. Approximately 75% appear suitable for community aural care clinics.
CONCLUSIONS
OE occurs most commonly in female patients, often with associated risk factors. Patients often consult primary care several times prior to referral. Lifestyle advice and ototopical drops are frequently overlooked; instead, often inappropriately treated with oral antibiotics. Most ears were anatomically normal, and community aural care clinics may have a role in more timely and accessible treatment.
Topics: Anti-Bacterial Agents; Critical Pathways; Female; Humans; Hypersensitivity; Male; Middle Aged; Otitis Externa; Referral and Consultation
PubMed: 35022709
DOI: 10.1093/fampra/cmab181 -
Journal of Feline Medicine and Surgery May 2021Chronic otitis can be one of the most frustrating diseases to manage for a small animal practitioner. While it occurs less commonly in the cat than the dog, it is no... (Review)
Review
PRACTICAL RELEVANCE
Chronic otitis can be one of the most frustrating diseases to manage for a small animal practitioner. While it occurs less commonly in the cat than the dog, it is no less challenging. The purpose of this review is to discuss the common and uncommon causes of chronic otitis in the cat within the clinical framework used for diagnosis and treatment. The focus is on diseases that affect the ear canal, rather than those restricted to the pinnae.
CLINICAL CHALLENGES
Otitis is multifactorial, which complicates management. A common clinical mistake is to focus solely on treating the infection present. Only by addressing all factors will a clinician successfully control chronic otitis. For the purposes of this review, the authors have adopted the established model of separating primary, predisposing and perpetuating causes of otitis. Primary factors are those that directly cause otitis (inflammation); predisposing factors are those that put the patient at risk for development of otitis; and perpetuating factors are those that result in ongoing clinical signs of otitis or that prevent clinical resolution.
AUDIENCE
This review is aimed at veterinarians who treat cats and particularly those with an interest in feline dermatology and otology.
EQUIPMENT
While many practitioners rely on a hand-held otoscope, a video-otoscope can be very helpful for the diagnosis and treatment of chronic otitis.
EVIDENCE BASE
This review presents up-to-date information regarding the diagnosis and treatment of chronic otitis in cats, with emphasis on the most recent peer-reviewed literature.
Topics: Animals; Cat Diseases; Cats; Inflammation; Otitis; Otitis Externa
PubMed: 33896249
DOI: 10.1177/1098612X211007072 -
American Journal of Otolaryngology 2021The current study showed the relation between otitis externa and COVID-19 infection and compared otitis externa with other symptoms of COVID-19 as anosmia.
OBJECTIVE
The current study showed the relation between otitis externa and COVID-19 infection and compared otitis externa with other symptoms of COVID-19 as anosmia.
METHODS
257 cases who were confirmed positive for COVID-19, were examined otoscopic and endoscopic for otitis externa, onset of starting symptoms of otitis externa and its relation to days of infection with COVID-19 were documented and the prevalence of otitis externa with anosmia in the study group were estimated.
RESULTS
Increased incidence of otitis externa in COVID-19 patients (18% of study group) and symptoms starting mainly between the 5th to 8th day of COVID-19 infection. Combined otitis externa and anosmia occurred in 13% of study group.
CONCLUSIONS
Otitis externa has a relation to COVID-19 infection. Further research needed to study its pathogenesis and mechanisms.
Topics: Adolescent; Adult; Aged; COVID-19; Cross-Sectional Studies; Female; Humans; Incidence; Male; Otitis Externa; Pandemics; Pneumonia, Viral; Prevalence; Risk Factors; SARS-CoV-2
PubMed: 33248797
DOI: 10.1016/j.amjoto.2020.102672 -
The Journal of Laryngology and Otology Jul 2022Necrotising otitis externa is a severe ear infection for which there are no established diagnostic or treatment guidelines.
BACKGROUND
Necrotising otitis externa is a severe ear infection for which there are no established diagnostic or treatment guidelines.
METHOD
This study described clinical characteristics, management and outcomes for patients managed as necrotising otitis externa cases at a UK tertiary referral centre.
RESULTS
A total of 58 (63 per cent) patients were classified as definite necrotising otitis externa cases, 31 (34 per cent) as probable cases and 3 (3 per cent) as possible cases. Median duration of intravenous and oral antimicrobial therapy was 6.0 weeks (0.49-44.9 weeks). Six per cent of patients relapsed a median of 16.4 weeks (interquartile range, 23-121) after stopping antimicrobials. Twenty-eight per cent of cases had complex disease. These patients were older ( 0.042), had a longer duration of symptoms prior to imaging ( < 0.0001) and higher C-reactive protein at diagnosis ( 0.005). Despite longer courses of intravenous antimicrobials (23 14 days 0.032), complex cases were more likely to relapse ( 0.016).
CONCLUSION
A standardised case-definition of necrotising otitis externa is needed to optimise diagnosis, management and research.
Topics: Anti-Bacterial Agents; Humans; Otitis Externa; Retrospective Studies
PubMed: 35042578
DOI: 10.1017/S002221512100462X