1/47. 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 = organ (Clic here for more details about this article) |
2/47. Malignant otitis externa caused by malassezia sympodialis.BACKGROUND: Malignant otitis externa caused by fungal infections is rare. A review of the literature showed only 9 cases, and the causative fungus in all cases was aspergillus. This article reports an unusual case caused by malassezia sympodialis. methods: A 53-year-old man with non-insulin dependent diabetes presented with malignant otitis externa. He deteriorated despite treatment with intravenous antipseudomonal therapy and surgical debridement. Microbiologic tests revealed M. sympodialis. He responded rapidly to intravenous amphotericin. RESULTS: Systemic human infections caused by M. sympodialis have not been reported. M. furfur systemic infection is rare and has been associated lipid hyperalimentation by means of a central catheter. Only 1 other case of M. fungemia without these associated risk factors has been reported. CONCLUSIONS: The first case of malignant otitis externa caused by M. sympodialis is presented. It highlights the difficulty of initial biologic diagnosis and the need for lipid-enriched media to grow this fastidious organism.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
3/47. A case of malignant otitis externa following mastoidectomy.We present a case of a 63-year-old diabetic male who developed malignant otitis externa following mastoidectomy. Extensive skull base osteomyelitis caused thrombosis of the jugular bulb and subsequent paralysis of cranial nerves VII, IX, X and XII. He was treated aggressively with intravenous antibiotics and debridement of granulation tissue in the mastoid bowl with full recovery of the cranial nerve palsies associated with recanalization of the jugular bulb. We believe this is the first reported case of malignant otitis externa to occur following mastoidectomy with complete recovery of the cranial nerve paresis.- - - - - - - - - - ranking = 139.80355349107keywords = nerve (Clic here for more details about this article) |
4/47. Fungal malignant otitis externa due to scedosporium apiospermum.Malignant otitis externa (MOE) is an infection of the external auditory canal that invades the skull base. aspergillus species fungi were the pathological organism in 21 of 23 reported cases of fungal MOE. We report on a 21-year-old man with end-stage acquired immunodeficiency syndrome (AIDS) and fungal MOE caused by scedosporium apiospermum. Fungal MOE is most common in patients with end-stage AIDS and hematologic malignancies. granulation tissue is not a common finding in these patients, and the infectious process often starts in the mastoid air cells or middle ear space, as opposed to the external auditory canal. Surgical debridement and amphotericin b are the mainstays of therapy; resolution of the infection depends greatly on the severity of the underlying disease.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
5/47. A worrying development in the microbiology of otitis externa.methicillin-resistant staphylococcus aureus (MRSA) is causing growing concern in hospitals. There has been a steady increase in the number of cases of nosocomial MRSA infections recently and this will no doubt apply to otitis externa, one of the most common ENT infections. The total number of cases of otitis externa presenting to the Accident and Emergency Department over a 3-month period was recorded and the offending microbes cultured and tested for drug sensitivities. Although pseudomonas aeruginosa was the most frequent organism, 30% of patients grew S. aureus. Of these, 6% (15 patients) were MRSA cultures. The contact histories, antibiotic sensitivities and treatment of these 15 patients were studied. Recommendations as a result of this study include the routine culture and sensitivity in otitis externa and where MRSA is cultured, a full contact history should be elicited and appropriate precautions taken. Specifically, a history of hospital contact should be sought. Treatments used successfully in the treatment of MRSA otitis externa were aural toilet and fucidic acid-betamathasone 0.5% wicks where the organism was gentamycin-resistant (GMRSA), whereas aural toilet with aminoglycoside-steroid drops was sufficient if it was gentamycin-sensitive.- - - - - - - - - - ranking = 2keywords = organ (Clic here for more details about this article) |
6/47. Malignant otitis externa in an infant with selective iga deficiency: a case report.The occurrence of malignant otitis externa (MOE) in infancy is rare. We report a case of MOE in a neonate who was later identified to have selective iga deficiency. She was successfully treated with oral ciprofloxacin, but developed external auditory canal stenosis, a deformed pinna, persistent facial nerve palsy, temporal bone erosion and hearing loss. No cases of MOE in selective iga deficiency have been reported in literature. This is also the first report on the use of ciprofloxacin in infants with MOE.- - - - - - - - - - ranking = 46.601184497024keywords = nerve (Clic here for more details about this article) |
7/47. Malignant external otitis with multiple cranial nerve involvement.A case of bilateral malignment external otitis with multiple cranial nerve deficits is presented. Thirty-five similar cases reported in the world literature are reviewed. All cranial nerves have been involved with the exception of the first and fourth. The resultant pseudomonas ostemyelitis may be spread extensively in these elderly diabetic patients to involve the entire base of the skull as well as other structures. The preferred treatment is long term systemic antibiotics followed by surgical intervention for plateau or further progression of disease. The overall mortality is 61 percent (22/36), a lower figure than previously reported.- - - - - - - - - - ranking = 279.60710698215keywords = nerve (Clic here for more details about this article) |
8/47. Idiopathic inflammatory medial meatal fibrotizing otitis.BACKGROUND: Idiopathic inflammatory medial meatal fibrotizing otitis (IMFO) is rare. Only a few cases with unknown cause have been reported. OBJECTIVE: To report 3 cases of IMFO as a specific diagnostic entity. patients AND methods: Two adults and 1 child with bilateral IMFO were observed for several years at the Department of Otorhinolaryngology of Helsinki University Hospital, Helsinki, finland. RESULTS: Only the osseous part of the external ear canals was affected by IMFO. The skin and skin organs over the lateral cartilage of the ear canals remained rigorously and constantly uninflamed through the active, relentless progression of the disease over several years, resulting in the formation of a fibrous plug of the medial meatal canal. The middle ears and mastoid air cells were not affected during the active inflammatory phase. CONCLUSION: IMFO has its own specific pathophysiologic characteristics, and perhaps also etiopathologic characteristics, which are still unknown.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
9/47. Central skull base osteomyelitis in patients without otitis externa: imaging findings.BACKGROUND AND PURPOSE: skull base osteomyelitis typically arises as a complication of ear infection in older diabetic patients, involves the temporal bone, and has pseudomonas aeruginosa as the usual pathogen. Atypical skull base osteomyelitis arising from the sphenoid or occipital bones without associated external otitis occurs much less frequently and initially may have headache as the only symptom. The purpose of this study was to review the clinical and MR imaging features of central skull base osteomyelitis. methods: We retrospectively reviewed MR images obtained in six patients with central skull base osteomyelitis. No patient had predisposing external otitis or osteomyelitis of the temporal bone. RESULTS: All of our patients presented with headache, no external ear pain, and cranial nerve deficits. Five of six patients had a predisposition to infection, and the erythrocyte sedimentation rate was elevated in the five patients in whom it was checked. In each case, the diagnosis was delayed until MR imaging demonstrated central skull base abnormality, and the diagnosis was then confirmed with tissue sampling. The most consistent imaging findings were clival bone marrow T1 hypointensity and preclival soft tissue infiltration. Five of six patients were cured with no recurrence of skull base infection over a 2-4-year follow-up period. CONCLUSION: In the setting of headache, cranial neuropathy, elevated erythrocyte sedimentation rate, and abnormal clival imaging findings, central skull base osteomyelitis should be considered as the likely diagnosis. Early tissue sampling and appropriate treatment may prevent or limit further complications such as intracranial extension, empyema, or death.- - - - - - - - - - ranking = 46.601184497024keywords = nerve (Clic here for more details about this article) |
10/47. 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 = organ (Clic here for more details about this article) |
| | Next -> |