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The aetiology of otitis externa--a new concept.

This paper reports the results of middle ear pressure measurements on 33 patients with recurrent otitis externa and compares the results with those of 21 normal subjects. The maximum negative pressure in the control group was -50 mm. of water, while 17 patients (52%) with recurrent otitis externa recorded measurements of -100 mm. of water or more. It is postulated that chronic Eustachian tube dysfunction may interfere with the normal migration of epithelium from the tympanic membrane along the external auditory meatus leading to irritation and chronic infection. The treatment in these cases should be directed at the underlying cause of the Eustachian tube dysfunction.

Adult↗

Malignant otitis externa due to Aspergillus niger.

The case is reported of a 73-y-old diabetic man with malignant otitis externa due to Aspergillus niger. Cure was achieved with a 3 week course of intravenous amphotericin B, followed by oral itraconazole for 3 months. The characteristics and the outcome of 13 reported cases of malignant otitis externa caused by Aspergillus sp. are presented.

Administration, Oral↗

[Malignant otitis externa with diabetes mellitus insulin-dependent patients].

Malignant otitis externa is non-taming skin and soft tissues of the outer hearing canal infection tending to expand towards temporal bone and the base of the skull. The infection is usually caused by Pseudomonas aeuroginosa, sometimes by Staphilococcus aureus or Klebsiela. In 90% cases the patients are diabetics, mainly in older age. A nineteen years old girl with insulindependent diabetes mellitus and having malignant externa is shown.

Adult↗

Otitis externa.

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Humans↗

Otitis externa.

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Humans↗

Otitis externa.

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Humans↗

[Antimicrobial activity of ofloxacin against recent clinical isolates from otitis media and otitis externa].

In order to evaluate the annual changes of susceptibility, minimum inhibitory concentrations (MICs) of ofloxacin (OFLX) and 4 control drugs were determined against clinical isolates that were obtained from patients with otitis media and otitis externa during the periods between January and December 1993, and the periods between October 1996 and March 1997. The results are summarized as follows: 1. No annual changes were seen for MIC50 of OFLX, but MIC80 and MIC90 of that rose against methicillin-resistant Staphylococcus aureus (MRSA), coagulase-negative staphylococci (CNS) and Pseudomonas aeruginosa from 1993 to 1996. It appears that resistance to OFLX is increasing among these bacteria. Detection frequency of highly resistant strains to OFLX (MIC > 100 micrograms/ml) was lower than to other control drugs. 2. No annual changes were seen of MIC50, MIC80 and MIC90 of OFLX against methicillin-susceptible S. aureus (MSSA), Streptococcus spp., Proteus spp. and Haemophilus influenzae. OFLX showed strong antimicrobial activities against these bacteria. 3. Since there was no large annual changes in the antimicrobial activity of OFLX against clinical isolates that were obtained from patients with otitis media and otitis externa, OFLX otic solution was considered as one of the clinically useful drugs even now.

Anti-Infective Agents↗

Antibacterial sensitivity patterns of bacteria isolated from dogs with otitis externa.

From January, 1973, to December, 1975, the most prevalent microorganisms isolated from ear swab specimens taken from 323 dogs with otitis externa were Staphylococcus aureus, Pseudomonas aeruginosa, and Proteus spp. Comparison of the antibiograms of these isolants to those reported from England in 1961 and from the United States in 1970 suggested emergence of a greater proportion of bacterial strains with resistance to antibacterial agents commonly used to treat otitis externa of dogs.

Animals↗

Necrotizing otitis externa due to Aspergillus in an immunocompetent patient.

An 85-year-old, nondiabetic man is described with necrotizing (malignant) otitis externa. The patient developed facial nerve paralysis in the presence of a progressive cellulitis and chondritis of the external auditory meatus. Destruction of the bony meatus and mastoid and obliteration of normal soft-tissue planes at the skull base were documented by computed tomographic scans. Aspergillus fumigatus was isolated from the external meatus and deep tissue specimens. Fungal invasion of bone and soft tissue was confirmed histopathologically. Pseudomonas aeruginosa was never isolated. This case is unusual from both the standpoint of etiology and host susceptibility in that the patient had no apparent underlying disease. Amphotericin B and rifampin therapy following radical mastoidectomy halted the progression of disease. Finally, this case illustrates the pitfalls of empiric antibacterial therapy for necrotizing otitis externa without cultural confirmation of the etiologic agent.

Aged↗

An unsuspected alkaline battery foreign body presenting as malignant otitis externa.

We describe a case of an unsuspected button battery foreign body in the ear canal causing symptoms that mimic malignant otitis externa in a previously healthy 13 year old. Button batteries in the ear canal may cause extensive liquefactive necrosis of the surrounding tissue by leaking an alkaline electrolyte solution. Suspicion of a foreign body should be maintained in any child presenting with a complicated otitis externa. Prompt evaluation and removal of button batteries are necessary to prevent tissue destruction.

Adolescent↗

The relation of patient satisfaction with treatment of otitis externa to clinical outcomes: development of an instrument.

This survey was undertaken to develop a short, comprehensive measure of patient satisfaction with pharmacologic treatment for otitis externa and to assess the relationships between satisfaction, disease symptoms, and medication side effects. Otitis externa was diagnosed in 41 patients recruited from 6 sites; 34 patients completed and returned the study instruments and were included in the study. Patients or their caregivers administered polymyxin/neomycin/hydrocortisone ear drops prescribed by a physician and completed a daily diary for 10 days and a satisfaction questionnaire at the end of the treatment period. The main outcome measures were the subscale scores for patient satisfaction and their relation to medication side effects, symptoms of ear infection, activity limitations, pain, and adherence to prescription regimens. The questionnaire and its subscales demonstrated good psychometric properties (ie, reliability coefficients >0.75, except for 1 subscale). Overall satisfaction was found to be significantly correlated with relief of symptoms, ability to return to normal activities, ease of administration, and medication side effects. Satisfaction subscale scores were correlated with patient-reported severity of medication side effects and disease symptoms. More than half the patients took drops for more than the prescribed number of days, and one third took more than the prescribed number of drops per administration (ie, overadherence). The relation between satisfaction and adherence was weak, perhaps due to the high rates of overadherence. Our results demonstrate that patient satisfaction with otic medication can be assessed across various aspects of satisfaction and that it is correlated with reported disease symptoms and medication side effects. This type of multifaceted assessment may help physicians select between medications with different side-effect profiles and administration schedules. Larger studies are needed to evaluate the relationship between satisfaction with an otic medication and adherence to a medication regimen.

Adolescent↗

Malignant otitis externa due to Staphylococcus infection.

A case of malignant otitis externa occurring in a fit 25-year-old non-diabetic male is reported. The clinical and histological findings support this diagnosis but neither identification nor culture of Pseudomonas aeruginosa was made and the condition was bilateral. The only pathogen identified was Staphylococcus aureus which has been reported in only two previous cases.

Adult↗

Malignant otitis externa: the therapeutic evolution of a lethal infection.

Malignant otitis externa (MOE) is a potentially fatal infection of the external auditory canal caused by Pseudomonas aeruginosa in a majority of cases. Treatment of MOE has changed over the years. Surgical debridement of all infected tissue is no longer considered the treatment of choice and has been replaced by localized surgical debridement supplemented with long-term antimicrobial chemotherapy. The recent availability of the fluoroquinolones and in particular ciprofloxacin has opened up new therapeutic opportunities.

Aminoglycosides↗

Conchomeatoplasty for chronic otitis externa.

Chronic moisture is a major cause of chronic otitis externa (COE). Moisture combined with inadequate lubrication of the stratum corneum and retention of keratin debris promote bacterial and fungal growth. In most cases of COE, creating a well-aerated, dry, self-cleaning external auditory canal prevents further infection. This can usually be accomplished by medical treatment that includes suction and swabbing. Antibiotic-steroid ear drops control infection and inflammation. Alcohol flush and warm-air ventilation dry the canal, and a hydrophobic cream lubricates and seals the stratum corneum from moisture, fungus, and bacteria. An anatomic variation, a narrow external auditory meatus leading to poor ventilation, is frequently associated with COE, which does not respond to conventional therapy. A previously unreported simple lateral conchomeatoplasty is presented. No other described meatoplasty corrects both the conchal cartilage projection and inadequate meatal skin circumference which, together, cause the small meatus. The lateral conchomeatoplasty has been used by this author for over 20 years on 35 ears. All patients showed improvement; most had complete control.

Chronic Disease↗

[Value of hyperbaric oxygen therapy in the treatment of malignant otitis externa. Apropos of a case].

The authors report the case of a 75 years old insulin dependent diabetic man presenting a malignant otitis externa with facial nerve paralysis. Despite prolonged, adequate parenteral antibiotic therapy, the patient's clinical status did not improve. The addition of hyperbaric oxygen as a complementary treatment was followed by the regression of clinical signs and the resolution of infection. Based upon a review of the literature, the authors discuss the indications for this therapy and the problems involved in defining the criteria of cure in malignant otitis externa.

Aged↗

[The treatment of necrotizing otitis externa with a combination of surgery, antibiotics, specific immunoglobulins and hyperbaric oxygen therapy. Results of the Ulm Treatment Concept].

BACKGROUND: Even today, necrotizing otitis externa is still a life-threatening condition. The standard treatment concepts based on antibiotic therapy, topical treatment and--if necessary--surgical debridement of necrotic tissue, remain ineffective in many cases. In advanced stages, necrotizing otitis externa can therefore be expected to result in severe functional impairment or even a fatal outcome. PATIENTS AND METHODS: We describe our experience with a multimodal treatment concept that we have been using with great success at the Federal Armed Forces Hospital in Ulm since 1987. This treatment is based on four pillars: 1. Surgical debridement, 2. Use of a combination of antibiotics, and 3. Administration of specific immunoglobulins, accompanied by, 4. Hyperbaric oxygen therapy RESULTS: Over a period of more than 5 years 16 of the 22 patients treated on the basis of this multimodal concept remained free of recurrences. In addition, significant reductions in analgesic use and in the insulin doses needed by diabetic patients were possible. CONCLUSIONS: The treatment concept under scrutiny has proved particularly successful. The various modes involved and the results of this combined therapy are discussed.

Acinetobacter Infections↗