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European Archives of... Apr 2024Achromobacter xylosoxidans is an emerging pathogen mainly associated with resistant nosocomial infections. This bacteria had been isolated in the ear together with other...
PURPOSE
Achromobacter xylosoxidans is an emerging pathogen mainly associated with resistant nosocomial infections. This bacteria had been isolated in the ear together with other pathogens in cultures from patients with chronic otitis media, but it had never been reported as a cause of osteomyelitis of the external auditory canal.
CASE PRESENTATION
We present a unique case of a healthy 81-year-old woman who presented with left chronic otorrhea refractory to topical and oral antibiotic treatment. Otomicroscopy revealed an erythematous and exudative external auditory canal (EAC) with scant otorrhea. The tympanic membrane was intact, but an area of bone remodeling with a small cavity anterior and inferior to the bony tympanic frame was observed. Otic culture isolated multi-drug-resistant A. xylosoxidans, only sensitive to meropenem and cotrimoxazole. Temporal bone computed tomography showed an excavation of the floor of the EAC compatible with osteomyelitis. Targeted antibiotherapy for 12 weeks was conducted, with subsequent resolution of symptoms and no progression of the bone erosion.
CONCLUSIONS
Atypical pathogens such as A. xylosoxidans can be the cause of chronic otitis externa. Early diagnosis and specific antibiotherapy can prevent the development of further complications, such as osteomyelitis. In these cases, otic cultures play an essential role to identify the causal germ. This is the first case of EAC osteomyelitis due to A. xylosoxidans reported to date.
Topics: Female; Humans; Aged, 80 and over; Ear Canal; Achromobacter denitrificans; Otitis Externa; Osteomyelitis; Ear Diseases
PubMed: 38367073
DOI: 10.1007/s00405-024-08465-8 -
Reassessing the Utility of Surgical Intervention for Skull Base Osteomyelitis: A 16-Year Experience.Otolaryngology--head and Neck Surgery :... Jul 2024The role of surgery in lateral skull base osteomyelitis (SBO) is controversial. Surgical intervention is often requested by consulting services in the interest of...
OBJECTIVE
The role of surgery in lateral skull base osteomyelitis (SBO) is controversial. Surgical intervention is often requested by consulting services in the interest of additional culture data to inform medical management. However, whether surgery alters subsequent antibiotic treatment or modifies disease outcome remains unknown. The aim of this study was to investigate the role of surgical intervention in the treatment of SBO by (1) comparing nonsurgical and surgical culture data and (2) assessing clinical outcomes and treatment course following surgical intervention.
STUDY DESIGN
Retrospective.
SETTING
Tertiary care center.
METHODS
The electronic record was queried for all patients with SBO who presented to a single institution over a 16-year period (2007-2023). Information recorded included history and exam, bedside and intraoperative culture data, antibiotic course, and disease outcomes. Primary outcome measures included change in medical management based on intraoperative cultures, recurrence rates, and mortality rates.
RESULTS
Forty patients (41 ears, average age 73 ± 13 years) met inclusion criteria. Out of 13 (32%) patients who underwent surgical intervention, one intraoperative culture changed the antibiotic course due to identification of resistance to the original antibiotic used. Surgery did not demonstrate a benefit in overall mortality (23% vs 18%, P = 0.36) or facial nerve function (33% vs 50%, P = 0.56) compared to medical management, and was associated with increased recurrence rates (54% vs 11%, P = 0.05).
CONCLUSION
Surgical cultures rarely changed antibiotic selection. Surgical debridement in treatment-refractory SBO was also not associated with improvement in recurrence or mortality rates, though this may reflect underlying differences in disease severity.
Topics: Humans; Retrospective Studies; Osteomyelitis; Male; Female; Skull Base; Aged; Anti-Bacterial Agents; Middle Aged; Treatment Outcome; Aged, 80 and over
PubMed: 38344847
DOI: 10.1002/ohn.661 -
The British Journal of Radiology Mar 2024Skull base osteomyelitis (SBO) is a late manifestation of complicated otogenic infections that presents a diagnostic challenge. Delayed or missed diagnoses lead to high...
Skull base osteomyelitis (SBO) is a late manifestation of complicated otogenic infections that presents a diagnostic challenge. Delayed or missed diagnoses lead to high morbidity and mortality and can be attributed to non-specific symptoms, subtle early radiologic findings, radiologic mimicry of nasopharyngeal carcinoma (NPC), and under-recognition from clinician and radiologists. This pictorial review aims to emphasize on early imaging recognition and distinction between SBO and NPC.
Topics: Humans; Delayed Diagnosis; Diagnostic Imaging; Skull Base; Nasopharyngeal Carcinoma; Osteomyelitis; Nasopharyngeal Neoplasms
PubMed: 38335140
DOI: 10.1093/bjr/tqae015 -
Head and Neck Pathology Feb 2024A 48-year-old man presented with a chief complaint of intermittent right ear otorrhea of several-month duration, occasional otalgia and progressive unilateral hearing...
A 48-year-old man presented with a chief complaint of intermittent right ear otorrhea of several-month duration, occasional otalgia and progressive unilateral hearing impairment. He also reported frequent episodes of headache and pressure in the sinuses and maxilla. Previous systemic treatment with antibiotics failed to alleviate the symptoms. A head/neck CT showed completely normal mastoid, middle ear and external auditory canal regions without any evidence of opacification or bone erosion. Otoscopic examination of the right ear disclosed aggregates of dried, brown, fibrillar material and debris occluding the external auditory canal and obstructing the otherwise intact tympanic membrane. Dilation of the external auditory canal or thickening of the tympanic membrane were not appreciated. The canal was debrided and the fibrillar material was placed in formalin. Histopathologic examination revealed numerous branching, septated fungal hyphae organized in densely-packed clusters. In other areas, the fungal hyphae abutted or were attached to lamellated collections of orthokeratin. As highlighted by GMS staining, the fungi were morphologically compatible with Aspergillus species. The clinicopathologic findings supported a diagnosis of fungal otitis externa, while the numerous anucleate squamous cells were compatible with colonization of an underlying, probably developing, cholesteatoma. Culture of material isolated from the external auditory canal confirmed the presence of Aspergillus flavus. In this illustrative case, we present the main clinical and microscopic characteristics of Aspergillus-related otomycosis developing in the setting of a tautochronous cholesteatoma.
Topics: Male; Humans; Middle Aged; Otomycosis; Aspergillus flavus; Otitis Externa; Ear Diseases; Ear Canal; Cholesteatoma
PubMed: 38334859
DOI: 10.1007/s12105-023-01606-1 -
Cureus Jan 2024Skull base osteomyelitis is a not commonly encountered but potentially fatal consequence of untreated necrotizing otitis externa. Early recognition and appropriate...
Skull base osteomyelitis is a not commonly encountered but potentially fatal consequence of untreated necrotizing otitis externa. Early recognition and appropriate treatment are crucial to prevent serious complications such as cranial nerve palsies, meningitis, and intracranial abscess formation. The case reports presented in this study provide a rich depiction of the clinical presentation, diagnostic challenges, and interventions employed. Early recognition and appropriate management of skull base osteomyelitis are crucial to prevent complications and improve patient outcomes.
PubMed: 38333479
DOI: 10.7759/cureus.51973 -
The Journal of Laryngology and Otology Feb 2024
Topics: Humans; Otitis Externa; Epistaxis; First Aid; Students, Medical; Otolaryngology
PubMed: 38314745
DOI: 10.1017/S0022215124000045 -
European Journal of Dermatology : EJD Oct 2023
Topics: Humans; Chronic Disease; Otitis Externa
PubMed: 38297949
DOI: 10.1684/ejd.2023.4591 -
Veterinary Dermatology Jun 2024Canine middle ear effusion (MEE) is usually asymptomatic, being an incidental finding when computed tomography or magnetic resonance imaging (MRI) of the head is...
BACKGROUND
Canine middle ear effusion (MEE) is usually asymptomatic, being an incidental finding when computed tomography or magnetic resonance imaging (MRI) of the head is performed for other reasons unrelated to otic disease. The clinical relevance of the presence of material in the tympanic bulla (TB) remains uncertain, and more detail about its prevalence and appearance in MRI are required.
OBJECTIVE
To assess the prevalence of presence of material within the TB of French bulldogs (FB) with no clinical signs suggestive of otitis (externa, media or interna) that underwent high-field MRI for other medical reasons.
ANIMALS
Two hundred fifty-two TB of 126 FB were included in this study.
MATERIALS AND METHODS
Nonexperimental retrospective study in which MRI images were evaluated by a board-certified veterinary radiologist.
RESULTS
Fifty-eight per cent of the dogs had material in the TB lumen (46% of the TB) and 59% were bilaterally affected. The signal intensity of this material related to the grey matter was variable on T1w and mainly hyperintense on T2w sequences.
CONCLUSION AND CLINICAL RELEVANCE
FB are predisposed to MEE. This is important when assessing imaging studies of TB of FB with chronic otitis externa, as high percentage of cases may have concurrent MEE. MRI findings in FB with MEE are characterised by a hyperintense signal to the grey matter on T2w in most cases and variable on T1w sequences.
Topics: Animals; Dogs; Retrospective Studies; Magnetic Resonance Imaging; Dog Diseases; Male; Female; Prevalence; Otitis Media with Effusion; Ear, Middle
PubMed: 38284304
DOI: 10.1111/vde.13239 -
Clinical Otolaryngology : Official... May 2024Necrotizing otitis externa (NOE) is a serious, progressive, and potentially life-threatening infection of the external auditory canal, affecting soft tissue and bone....
Diagnostic accuracy of eosinophil-to-lymphocyte ratio and eosinophil-to-neutrophil ratio as biomarkers for differentiating between fungal and bacterial infection in necrotising otitis externa.
INTRODUCTION
Necrotizing otitis externa (NOE) is a serious, progressive, and potentially life-threatening infection of the external auditory canal, affecting soft tissue and bone. The most common organism causing NOE is Pseudomonas Aeruginosa and less common are Fungal infections. When managing a patient with NOE, a culture is taken from the EAC in order to tailor the appropriate antimicrobial treatment, however commonly, the culture is sterile. Inflammation biomarkers may be used as adjuncts to inform on the differential diagnosis and as prognostic markers.
AIM
To characterize and compare values and ratios of components of the complete blood count (CBC) at admission, at patients with positive swab culture.
METHODS
A retrospective study of NOE patients was conducted. We included all patients admitted between the years 2001-2023, for whom a culture swab tested positive. We compared CBC findings at hospitalization between bacteria and fungi-positive culture patients.
RESULTS
Eosinophils-to-Neutrophils Ratio (ENR) was significantly lower in the fungal group compared to the bacterial group 0.023 ± 0.02 and 0.04 ± 0.03, respectively (p-value = 0.025). Eosinophils-to-Leukocyte Ratio (ELR) was significantly lower in the fungal group compared to the bacterial group 0.058 ± 0.04 and 0.12 ± 0.1 respectively (p-value = 0.009). For definition of ELR ≤ 0.1 we found that, sensitivity was 88% (95%CI = 0.679-0.979) and NPV 90% (95%CI = 0.709-0.982). For definition of ENR ≤ 0.03 sensitivity was 88% (95%CI = 0.679-0.979) and NPV 88% (95%CI = 0.679-0.979).
CONCLUSION
Lower values of ELR and ENR in patients with NOE are associated with fungal infection and can serve as a tool in adjusting an appropriate antimicrobial therapy in cases of sterile or when no culture is available.
Topics: Humans; Eosinophils; Neutrophils; Otitis Externa; Retrospective Studies; Lymphocytes; Biomarkers; Bacterial Infections; Anti-Infective Agents
PubMed: 38263617
DOI: 10.1111/coa.14142 -
Cureus Jan 2024Skull base osteomyelitis (SBO) is a rare yet serious intratemporal infection that often masquerades as a skull base malignancy. It is most common in diabetic and...
Skull base osteomyelitis (SBO) is a rare yet serious intratemporal infection that often masquerades as a skull base malignancy. It is most common in diabetic and immunocompromised patients. We present a case of an elderly diabetic patient with end-stage renal disease with progressive malignant otitis externa. The disease progressed to involve the base of the skull, causing multiple cranial neuropathies. Early initiation of intravenous (IV) antibiotics, along with supportive treatment, may improve the long-term prognosis of the disease. This case highlights the importance of keeping a high index of diagnostic suspicion for SBO in patients with risk factors. Early diagnosis and prompt treatment can drastically decrease morbidity and mortality due to SBO.
PubMed: 38173950
DOI: 10.7759/cureus.51560