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The Laryngoscope Sep 2020To determine independent risk factors for 30-day readmission, prolonged length of stay (PLOS), and discharge to a rehabilitation facility for those with malignant otitis...
OBJECTIVES
To determine independent risk factors for 30-day readmission, prolonged length of stay (PLOS), and discharge to a rehabilitation facility for those with malignant otitis externa.
METHODS
Retrospective cohort study of patients hospitalized with malignant otitis externa (International Classification of Diseases, 9th edition, code 380.14) in the Nationwide Readmissions Database (2013-2014). Overall and disease-specific complication and mortality data were analyzed using chi-squared and multivariate analysis.
RESULTS
There were 1267 cases of malignant otitis externa extracted. A PLOS of ≥8 days (90th percentile) was found in 14.2% (n = 180) of patients, and 13.7% (n = 174) were discharged to a facility. Patients were readmitted within 30 days at a rate of 12.5% (n = 159). The overall rates of uncomplicated and complicated diabetes were found to be 42.1% and 17.8%, respectively. Factors independently associated with PLOS included undergoing a surgical procedure (odds ratio [OR] 2.08, P < .001), and having central nervous system complications (OR 3.21, P < .001). Independent risk factors for disposition to a facility included nutritional deficiency (OR 1.91, P = .029), PLOS (OR 4.61, P < .001), and age 65-79 years (OR 6.57, P = .001). Readmission was independently linked to PLOS (OR 3.14, P < .001). Diabetes was not an independent risk factor for any outcome.
CONCLUSIONS
Thirty-day readmission, PLOS, and ultimate discharge to a rehabilitation facility were common and closely intertwined. Despite the classic association between diabetes and malignant otitis externa, diabetes was not an independent risk factor for any of our outcomes.
LEVEL OF EVIDENCE
4 Laryngoscope, 130:2220-2228, 2020.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Databases, Factual; Ear Neoplasms; Female; Humans; Length of Stay; Logistic Models; Male; Middle Aged; Odds Ratio; Otitis Externa; Patient Discharge; Patient Readmission; Retrospective Studies; Risk Factors; Time Factors; United States; Young Adult
PubMed: 31758583
DOI: 10.1002/lary.28409 -
The American Journal of Emergency... Aug 2020Malignant otitis externa (MOE) is a progressive infection of the external auditory canal (EAC). This disease is rare but has severe morbidity and mortality. (Review)
Review
INTRODUCTION
Malignant otitis externa (MOE) is a progressive infection of the external auditory canal (EAC). This disease is rare but has severe morbidity and mortality.
OBJECTIVE
This narrative review provides an overview of malignant otitis externa for emergency clinicians.
DISCUSSION
MOE is an invasive external ear infection that spreads to the temporal bone and can further progress to affect intracranial structures. Complications of advanced MOE include cranial nerve involvement, most commonly the facial nerve, and intracranial infections such as abscess and meningitis. The most common causative agent of MOE is Pseudomonas aeruginosa, but others include methicillin-resistant Staphylococcus aureus and fungi. Major risk factors for MOE include diabetes mellitus, immunosuppression, and advanced age. Red flags for MOE include severe otalgia (pain out of proportion to exam) or severe otorrhea, neurologic deficits (especially facial nerve involvement), previously diagnosed otitis externa not responsive to therapy, and patients with major risk factors for MOE. Examination may show purulent otorrhea or granulation tissue in the EAC, and culture of EAC drainage should be performed. Diagnosis is aided by computed tomography (CT) with intravenous contrast, which may demonstrate bony destruction of the temporal bone or skull base. When suspecting MOE, early consultation with an otolaryngologist is recommended and antibiotics with pseudomonal coverage are needed. Most patients with MOE will require admission to the hospital.
CONCLUSIONS
MOE is a rare, yet deadly diagnosis that must be suspected when patients with immunocompromise, diabetes, or advanced age present with severe otalgia. Rapid diagnosis and treatment may prevent complications and improve outcomes.
Topics: Emergency Service, Hospital; Humans; Otitis Externa; Risk Factors
PubMed: 32505469
DOI: 10.1016/j.ajem.2020.04.083 -
Journal of Ayub Medical College,... 2022Necrotising Otitis Externa (NOE) has often posed some challenges in view of diagnosis and management by clinicians. One such challenge is the appropriate and timely use...
Necrotising Otitis Externa (NOE) has often posed some challenges in view of diagnosis and management by clinicians. One such challenge is the appropriate and timely use of imaging techniques, since its use is critical not only in diagnosis but also determining the extent and resolution of the disease. Hence, doctors in both primary and secondary health care need to be familiar with presenting symptoms, while specialists need to be appraised of advances in imagining techniques in management of NOE. Whilst there is a general consensus amongst clinicians on some aspects of management of NOE, there is very limited consensus on the use of imaging modalities. There is no single modality of imaging that can provide a complete picture of diagnosis, disease progression and resolution. There are some advantages and limitation of each methodology, which indicate that a multi-modal imaging technique at particular stages of the disease may provide better management outcomes. However, further research in this area is required, as there is not yet an established 'gold standard' for imaging in NOE.
Topics: Humans; Otitis Externa; Osteomyelitis; Tomography, X-Ray Computed
PubMed: 36566413
DOI: 10.55519/JAMC-04-8899 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Oct 2023Necrotizing otitis externa is a progressive infectious disease involving the external auditory canal and even the skull base, which can lead to serious complications and...
Necrotizing otitis externa is a progressive infectious disease involving the external auditory canal and even the skull base, which can lead to serious complications and even death if not treated in time. In this paper, the latest advances in etiology, pathogenesis, clinical manifestations, diagnosis and treatment were reviewed based on previous literature, providing reference for clinical diagnosis, treatment and future research.
Topics: Humans; Otitis Externa; Skull Base; Ear Canal; Head
PubMed: 37828893
DOI: 10.13201/j.issn.2096-7993.2023.10.017 -
Mycoses Feb 2023Otomycosis is considered a recurring fungal ear infection. The external auditory canal provides an appropriate and optimal situation for fungal growth.
BACKGROUND
Otomycosis is considered a recurring fungal ear infection. The external auditory canal provides an appropriate and optimal situation for fungal growth.
OBJECTIVES
The study aimed to identify the causative agents of otomycosis and determine corresponding antifungal drug susceptibility patterns in north-western Iran.
METHODS
From October 2020 until November 2021, 200 patients attended an otolaryngology referral centre with otitis externa, and their ear discharge and debris were examined and cultured. The identification of the fungal agents was implemented by polymerase chain reaction-restriction fragment length polymorphism and sequencing. In vitro antifungal susceptibility testing of the isolates was conducted in accordance with the CLSI broth microdilution protocols.
RESULTS
The prevalence of otomycosis was measured 50.5% (n = 101/200). The majority of patients were in their forties (n = 35, 34.6%) and female (n = 57, 56.4%), and the most prevalent symptom was otalgia (56.4%). The most underlying factor was remarked manipulation employing a cotton swab (65.3%). Regarding fungus, Aspergillus section Nigri (58.57%) was the foremost isolate, followed by Aspergillus section Flavi (19.23%) and Candida parapsilosis (14.96%). The predominance of Aspergillus isolates had minimal in vitro sensitivity to tioconazole and nystatin. Candida species represented higher geometric mean minimum inhibitory concentrations (MIC) against nystatin. The MIC of three Aspergillus species isolates shown above the epidemiologic cut-off values (ECV) against itraconazole.
CONCLUSIONS
Otomycosis incidence surpassed in comparison with the previous study as the most common cause of otitis externa. The MIC distribution of Aspergillus species isolates against triazole antifungals is close to the defined ECVs and likely outrun it over time.
Topics: Humans; Female; Antifungal Agents; Otomycosis; Otitis Externa; Nystatin; Iran; Aspergillus; Microbial Sensitivity Tests
PubMed: 36134511
DOI: 10.1111/myc.13532 -
BMJ Open Feb 2023To establish consensus definitions for necrotising otitis externa (NOE) to facilitate the diagnosis and exclusion of NOE in clinical practice and expedite future... (Review)
Review
OBJECTIVE
To establish consensus definitions for necrotising otitis externa (NOE) to facilitate the diagnosis and exclusion of NOE in clinical practice and expedite future high-quality study of this neglected condition.
DESIGN
The work comprised of a systematic review of the literature, five iterative rounds of consultation via a Delphi process and open discussion within the collaborative. An expert panel analysed the results to produce the final outputs which were shared with and endorsed by national specialty bodies.
SETTING
Secondary care in the UK.
PARTICIPANTS
UK clinical specialists practising in infection, ear nose and throat (ENT) surgery or radiology.
MAIN OUTCOME MEASURES
Definitions and statements meeting the following criteria were accepted: (a) minimum of 70% of respondents in agreement or strong agreement with a definition/statement AND (b) <15% of respondents in disagreement or strong disagreement with a definition/statement.
RESULTS
Seventy-four UK clinicians specialising in ENT, Infection and Radiology with a special interest in NOE took part in the work which was undertaken between 2019 and 2021. The minimum response rate for a Round was 76%. Consensus criteria for all proposed case definitions, outcome definitions and consensus statements were met in the fifth round.
CONCLUSIONS
This work distills the clinical opinion of a large group of multidisciplinary specialists from across the UK to create practical definitions and statements to support clinical practice and research for NOE. This is the first step in an iterative process. Further work will seek to validate and test these definitions and inform their evolution.
Topics: Humans; Otitis Externa; Delphi Technique; Consensus; Radiology; United Kingdom
PubMed: 36806133
DOI: 10.1136/bmjopen-2022-061349 -
Otolaryngologic Clinics of North America Oct 2023Fungal infections of the external auditory canal can range from common (otomycosis) to life threatening (necrotizing otitis externa). Proper identification of fungal... (Review)
Review
Fungal infections of the external auditory canal can range from common (otomycosis) to life threatening (necrotizing otitis externa). Proper identification of fungal pathogens is necessary to guide appropriate therapy, and a high index of suspicion for fungal causes of ear canal disease is critical. Fungal pathogens may be an especially important cause of ear canal disease in certain populations, including patients with diabetes, patients recently treated with antibiotics, and immunosuppressed patients. Opportunistic fungal infections of the ear canal are an emerging concern.
Topics: Humans; Ear Canal; Otitis Externa; Mycoses; Ear Diseases; Anti-Bacterial Agents
PubMed: 37553272
DOI: 10.1016/j.otc.2023.06.010 -
Emergency Radiology Apr 2018Retinal detachment with subsequent silicone oil retinopexy is not uncommon. A known complication of silicone retinopexy is intraventricular migration of the intraocular...
Retinal detachment with subsequent silicone oil retinopexy is not uncommon. A known complication of silicone retinopexy is intraventricular migration of the intraocular silicone oil. While the oil itself does not result in direct pathology, misdiagnosis may lead to an unnecessary diagnostic workup and possibly predispose the patient to surgery intervention. Silicone oil typically appears hyperdense on computer tomography (CT) and hyperintense on T1-weighted magnetic resonance (MR). These imaging findings may mimic a mass or blood products. However, MR imaging of silicone results in chemical shift artifact which should help narrow the imaging differential. We present a patient with incidental CT and MRI findings which resulted in a prolonged hospital course following misidentification of intraventricular silicone oil. Although the imaging differential for an intraventricular lesion may include metastasis, lymphoma, hemorrhage, choroid plexus papilloma/carcinoma, meningioma, subependymoma, and ependymoma, secondary imaging findings should be noted to ensure an accurate diagnosis. In patients with evidence of prior silicone retinopexy, visualization of an intraventricular lesion with associated chemical shift artifact should raise the possibility of intraventricular silicone oil migration.
Topics: Adult; Cerebral Ventricles; Diagnosis, Differential; Foreign-Body Migration; Humans; Incidental Findings; Magnetic Resonance Imaging; Male; Otitis Externa; Retinal Detachment; Silicone Oils; Tomography, X-Ray Computed; Vitrectomy
PubMed: 29397464
DOI: 10.1007/s10140-018-1582-2 -
Open Veterinary Journal 2021Dermatological infections are the most common cases in the daily pet clinic. Since its discovery in 1990, subspecies have been reported more frequently in canine...
BACKGROUND
Dermatological infections are the most common cases in the daily pet clinic. Since its discovery in 1990, subspecies have been reported more frequently in canine otitis externa and pyoderma and even in cases of zoonoses.
AIM
Detect the presence of subsp. of canine otitis externa and pyoderma, its antimicrobial resistance, and the presence of Agen.
METHODS
Three-hundred-thirty-one swabs from dogs with otitis externa and pyoderma were cultured on bacteriological agar for bacterial isolation and subsequent biochemical and molecular identification. The identified subsp. were evaluated for their antimicrobial susceptibility using the Kirby-Bauer technique, including an oxacillin disk, and subsequently, a PCR was run to identify which ones had the A gene.
RESULTS
Thirty-four (22.97%) and twelve (6.56%) isolates were identified as subspecies from otitis externa and pyoderma, respectively. Fluoroquinolones, the most widely used group of antibiotics in Peru, showed a susceptibility of 58.82% (20/34) in cases of otitis externa and 50% (6/12) in cases of canine pyoderma. Meanwhile, nitrofurantoin was the antibiotic with the best efficacy in both cases, with 97% (33/34) in otitis externa and 83% (10/12) in pyoderma. Furthermore, 40% (13/34) of subsp. isolated from otitis externa were resistant to methicillin, and 85.29% (29/34) had the A gene. On the other hand, the only methicillin-resistant isolate from pyoderma was also the only one with a A gene.
CONCLUSION
This study is the first report of subsp. in Peru, finding a higher percentage than reported in other South American countries.
Topics: Animals; Dog Diseases; Dogs; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Otitis Externa; Pyoderma; Staphylococcus
PubMed: 34722197
DOI: 10.5455/OVJ.2021.v11.i3.5 -
The Journal of Laryngology and Otology Nov 2021Necrotising otitis externa is an aggressive infection of the external ear, which extends to the surrounding bone and soft tissue. In recent years, there has been an...
BACKGROUND
Necrotising otitis externa is an aggressive infection of the external ear, which extends to the surrounding bone and soft tissue. In recent years, there has been an apparent increase in the number of patients admitted to our hospital with this condition.
METHODS
A retrospective review was conducted of all patients admitted to our hospital with necrotising otitis externa between July 2012 and June 2020.
RESULTS
Among 39 patients included, only 9 were diagnosed in the first four years, and 30 were diagnosed in the last four years. There were 27 males and 12 females, and the mean age was 78.7 years. There were six non-diabetic immunocompetent patients. Cranial nerve palsies developed in 50 per cent of the patients. Disease-related mortality was 7.7 per cent. A favourable outcome was recorded in 66.7 per cent of the patients.
CONCLUSION
Necrotising otitis externa is associated with high morbidity and mortality. The incidence of the disease is rising in our local geographical area.
PubMed: 35317869
DOI: 10.1017/S0022215121003819