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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 -
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 -
Primary Care Mar 2014Acute otitis externa (AOE) is most often infectious in origin, and can be easily treated with a combination of topical antibiotic and steroid preparations. Systemic... (Review)
Review
Acute otitis externa (AOE) is most often infectious in origin, and can be easily treated with a combination of topical antibiotic and steroid preparations. Systemic antibiotics are rarely needed for AOE. Chronic otitis externa (COE) can be more difficult to treat, but if an underlying cause can be identified this condition can often be successfully managed. In both AOE and COE, prevention is fundamental. If patients are able to avoid precipitating factors, future episodes can often be averted.
Topics: Administration, Topical; Anti-Bacterial Agents; Diagnosis, Differential; Humans; Otitis Externa
PubMed: 24439876
DOI: 10.1016/j.pop.2013.10.001 -
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 -
MMW Fortschritte Der Medizin Jun 2019
Review
Topics: Anti-Bacterial Agents; Humans; Otitis Externa
PubMed: 31230310
DOI: 10.1007/s15006-019-0656-8 -
Pediatrics in Review Mar 2013
Review
Topics: Anti-Infective Agents; Humans; Otitis Externa
PubMed: 23457202
DOI: 10.1542/pir.34-3-143 -
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 -
Seminars in Roentgenology Jul 2019
Review
Topics: Diagnostic Imaging; Humans; Necrosis; Otitis; Otitis Externa
PubMed: 31376863
DOI: 10.1053/j.ro.2019.04.002 -
Pediatrics in Review Feb 2007
Review
Topics: Administration, Topical; Anti-Infective Agents, Local; Child; Child, Preschool; Diagnosis, Differential; Ear Diseases; Earache; Humans; Otitis Externa; Pediatrics; Secondary Prevention
PubMed: 17272526
DOI: 10.1542/pir.28-2-77 -
Otolaryngologic Clinics of North America Oct 2023Acute otitis externa, cellulitis of the external auditory canal, is most frequently due to bacteria. Patients may present with otalgia, aural fullness, hearing loss, and... (Review)
Review
Acute otitis externa, cellulitis of the external auditory canal, is most frequently due to bacteria. Patients may present with otalgia, aural fullness, hearing loss, and otorrhea. Its diagnosis is a clinical one. Treatment is focused on analgesia, treating the underlying infection and preventing recurrence.
Topics: Humans; Otitis Externa; Ear Canal; Hearing Loss; Acute Disease; Deafness
PubMed: 37516653
DOI: 10.1016/j.otc.2023.06.006