1/10. Necrotizing otitis externa caused by staphylococcus epidermidis.We present a case of malignant necrotizing otitis externa (MNOE) caused by staphylococcus epidermidis, which is usually a non-pathogenic microorganism. The patient is an otherwise healthy, nondiabetic 58-year-old white man. Contributory history began in 1994 after surgery for bilateral exostoses of the external auditory canals. Between April 1994 and May 1998 persistent otalgia occurred, with progressive mixed hearing losses, purulent discharge from both ears, spontaneous perforations of the tympanic membranes and ulceration of canal wall skin. From the beginning, Staph. epidermidis was isolated in all but one culture, but was not recognized as the pathological agent because of the presence of other more frequently involved bacteria and fungi. After multiple intravenous and oral antibiotics and antifungal treatments failed, further management involved frequent debridement of both external auditory canals and tympanic membranes, right tympanoplasty, bilateral mastoidectomy, revision tympanomastoidectomies and left modified radical mastoidectomy. Antistaphylococcal therapy including ceftazidime, vancomycin, teicoplanin, clindamycin and rifampicin was tried. Following the modified radical radical mastoidectomy, normalization of the status of his ears took approximately 2 months and has since remained stable to date. His left ear is deaf because of vancomycin administration, while magnetic resonance imaging and gallium scintigraphy have shown persistent inflammation of the skull base.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
2/10. temporomandibular joint involvement in malignant external otitis.OBJECTIVE: The purpose of this study was to present 6 patients with malignant external otitis (MEO) that resulted in temporomandibular joint (TMJ) involvement and to discuss the incidence, clinical presentation, and treatment modalities. STUDY DESIGN: All patients diagnosed with MEO between 1994 and 2002 were reviewed for cases in which the TMJ was invaded by the infectious process. Only patients in whom TMJ involvement was documented radiographically and in whom the clinical course was well documented were included in this study. RESULTS: MEO was diagnosed in 42 patients over an 8-year period; TMJ involvement was recorded in 6 patients (14%). The medical history revealed controlled type 2 diabetes mellitus in 4 of the 6 patients. All patients reported early ear symptoms, mainly otalgia and otorrhea. Local signs included an ear canal filled with granulation material, edematous overlying skin, and sensitivity to palpation. Cultures taken from the external ear were positive for either pseudomonas aeruginosa, staphylococcus epidermidis, Aspergillus, or proteus mirabilis. TMJ symptoms developed between 1 and 5 months after admission and included painful periauricular swelling and trismus. In 3 patients, healing was uneventful; 3 also died of the disease. CONCLUSIONS: TMJ involvement in MEO is associated with a resistant disease process, often with several recurrences. Prolonged administration of antibiotics is the treatment of choice. Surgical debridement of the TMJ is necessary for the positive identification of the pathogenic organism, in cases of abscess formation, or when osteomyelitic bone destruction of the condyle and glenoid fossa develop.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
3/10. Malignant external otitis: treatment with prolonged usage of antibiotics and Burow's solution.Malignant external otitis is a severe infection of the external auditory canal, generally caused by pseudomonas aeruginosa in elderly diabetics patients. We describe a case of malignant external otitis in a 63-year-old man with severe otalgia, purulent otorrhea and polypoid granulation of the external auditory canal. Local debridement, insulin treatment and 6-week intravenous antibiotic therapy with carbapemens were very effective and the granulation tissue disappeared completely. However, the patient readmitted for recurrent disease 3 weeks later, despite the oral and ear drop administration with new quinolone. No recurrence has been noted after 4-week additional treatment with intravenous carbapenems followed by 3-week treatment with Burow's solution as ear drops.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
4/10. Use of ceftazidime for malignant external otitis.During the past 2 years we have used ceftazidime (Fortaz), a third-generation cephalosporin, in the treatment of eight patients with progressive necrotizing "malignant" external otitis. ceftazidime is very active against Pseudomonas species and provides penetration into the CSF. Our results suggest that this medication has several advantages over the previously recommended combinations of aminoglycosides and semisynthetic penicillins, including improved cure rate, lower toxicity, and simpler administration schedules. We review our experience with ceftazidime in the treatment of eight patients.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
5/10. Treatment of pseudomonas aeruginosa auricular perichondritis with oral ciprofloxacin.pseudomonas aeruginosa auricular perichondritis can be a serious and expensive postoperative infection requiring prolonged hospitalization and intravenous administration of antibiotics. Oral antimicrobial agents have not been effective in the treatment of serious P. aeruginosa infections. Recently completed clinical trials have shown that oral ciprofloxacin, one of the new fluoroquinolone antimicrobials, is effective in the treatment of certain P. aeruginosa infections. We report two cases of P. aeruginosa auricular perichondritis successfully treated as outpatients with oral ciprofloxacin. This article also reviews the salient features of the new fluoroquinolones and their impact on antimicrobial therapy of serious skin and skin-structure infections.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
6/10. Relapsing malignant otitis externa successfully treated with ciprofloxacin.Two cases are presented, both patients with advanced relapsing malignant otitis externa. The antibiotic ciprofloxacin has strong anti-pseudomonal activity. It was given orally for six months to both patients, following administration of the traditional parenteral antibiotic courses, and in each case the disease has been extinguished. We therefore recommend that the management of patients shown to have malignant otitis externa should include strict diabetic control, regular local aural toilet, gentamicin ear drops and a six week course of parenteral antipseudomonal antibiotic agents (usually gentamicin and azlocillin) together with metronidazole to cover any anaerobic element in the infection. This regimen should be followed by a six month course of oral ciprofloxacin (750 mg b.d.). indium scans should be used to monitor recovery. We believe that this regimen can significantly reduce the morbidity and mortality of patients suffering from malignant otitis externa with cranial nerve involvement.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
7/10. Pseudomonas mastoiditis.opportunistic infections of the external auditory canal or the middle ear due to pseudomonas aeruginosa occurring in patients with low resistance to infection have a 35 percent mortality rate. Once the process extends into the pneumatized temporal bone, eradication becomes more difficult and the mortality rate increases to 72 percent because of the high incidence of involvement of cranial nerves, adjacent intracranial vessels, and meningitis. Treatment is directed towards the underlying condition, administration of systemic carbenicillin and gentamicin, topical colistin therapy, and judicious surgical debridement. Pseudomonas vaccine may be of help. Fifteen cases are presented. Nine follow the pattern of malignant external otitis and six began as a primary acute otitis media.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
8/10. Oral desensitization to penicillin in necrotizing (malignant) external otitis.Penicillin allergy can complicate the treatment of life-threatening infections. When a beta-lactam (penicillin) drug is the treatment of choice, true allergy can be safely overcome by a recent, oral method of desensitization to penicillin. Patients with positive skin test results can be desensitized within four hours with oral, subcutaneous, and then intramuscular administration of progressively increased doses of penicillin g. We used this method successfully in a patient with severe necrotizing (malignant) external otitis.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
9/10. Neutrophil disorders in a child with necrotizing external otitis.A two year old child presented with a history of cyclic fever since the sixth week of life, and otorrhea of six weeks' duration, unresponsive to treatment. Surgical removal of massive granulation tissue and sequestrated bone, combined with parenteral administration of pipellacillin and dibekacin successfully resolved the Pseudomonas infection. neutropenia and the decreased chemotactic activity of neutrophils were observed in this patient. This neutrophil disorder seemed to be primary and a contributing factor.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
10/10. Otic administration of amphotericin b 0.25% in sterile water.OBJECTIVE: To report otic administration of parenteral amphotericin b 0.25% in sterile water. CASE SUMMARY: A 44-year-old hiv man was diagnosed with otitis externa. The patient's past medical history was remarkable for positive coccidioides immitis serology for more than five months, essential hypertension, and Barrett's esophagitis. culture results from an ear swab revealed 4 aspergillus fumigatus and 3 Staphylococcus, coagulase negative. Antiinfective therapy for the otitis externa included oral and topical antibacterial and antifungal medications. amphotericin b 0.25% in sterile water was prepared by the pharmacy for topical otic administration. The otic amphotericin b was dispensed with instructions to refrigerate and assigned a one-week expiration date. The prescription called for instillation of 1-2 drops in each ear three times a day. The patient's signs and symptoms of otitis externa resolved during several weeks of antiinfective therapy. Topical administration of amphotericin b 0.25% in sterile water was not associated with any local adverse effects in this patient. DISCUSSION: The rationale for use of the parenteral amphotericin b formulation to prepare an otic dosage form, and the rationale for the specific concentration and expiration date chosen are discussed. CONCLUSIONS: This patient tolerated topical otic administration of amphotericin b 0.25% in sterile water when administered three times daily.- - - - - - - - - - ranking = 8keywords = administration (Clic here for more details about this article) |
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