Hostname: page-component-6766d58669-tq7bh Total loading time: 0 Render date: 2026-05-20T06:45:37.676Z Has data issue: false hasContentIssue false
  • English
  • Français

Prognostic scoring in necrotising otitis externa

Published online by Cambridge University Press:  09 July 2009

M O Eveleigh ,
C E J Hall  and
D L Baldwin
M O Eveleigh*
Affiliation:
Faculty of Medicine and Dentistry, University of Bristol, Bristol, United Kingdom
C E J Hall
Affiliation:
ENT Department, Southmead Hospital, North Bristol Hospitals NHS Trust, Bristol, United Kingdom
D L Baldwin
Affiliation:
ENT Department, Southmead Hospital, North Bristol Hospitals NHS Trust, Bristol, United Kingdom
*
Address for correspondence: Dr Mark Eveleigh, c/o Mr David Baldwin, ENT Department, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK. Fax: (+44) 1179 595850 E-mail: moeveleigh@doctors.org.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To collect and analyse data from the published literature concerning the rare condition necrotising otitis externa, in order to formulate a prognostic scoring model based on signs and symptoms.

Design:

Retrospective data collection from published literature, and binary logistic regression analysis of the effect on outcome of identified signs and symptoms.

Results:

Six factors were identified as prognostic of a poorer outcome, including facial nerve involvement, additional cranial nerve involvement, non-cranial nerve neurological involvement, extensive granulations (or oedema) in the external auditory canal, bilateral symptoms and aspergillus species as the causative organism. A four-point scoring model based on these findings is presented.

Conclusions:

A novel, systematic method of data analysis was utilised to construct a prognostic scoring model for necrotising otitis externa. This will better equip clinicians to treat this potentially fatal condition.

Keywords

External OtitisPseudomonas AeruginosaDiabetes MellitusOsteomyelitisCranial Nerve DiseasesAspergillusHyperbaric Oxygenation

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 10 , October 2009 , pp. 1097 - 1102
Copyright
Copyright © JLO (1984) Limited 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1Meltzer, PE, Kelemen, G. Pyocyaneous osteomyelitis of the temporal bone, mandible and zygoma. Laryngoscope 1959;169:1300–16CrossRefGoogle Scholar
2Chandler, JR. Malignant external otitis. Laryngoscope 1968;78:1257–94CrossRefGoogle ScholarPubMed
3Meyerhoff, WL, Gates, GA, Montalbo, PJ. Pseudomonas mastoiditis. Laryngoscope 1977;87:483–92CrossRefGoogle ScholarPubMed
4Rubin, J, Yu, VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis, and therapy. Am J Med 1988;85:391–8CrossRefGoogle ScholarPubMed
5Giamarellou, H. Malignant otitis externa: the therapeutic evolution of a lethal infection. J Antimicrob Chemother 1992;30:745–51CrossRefGoogle ScholarPubMed
6Coser, PL, Stamm, AE, Lobo, RC, Pinto, JA. Malignant external otitis in infants. Laryngoscope 1980;90:312–16CrossRefGoogle ScholarPubMed
7Ress, BD, Luntz, M, Telischi, FF, Balkany, TJ, Whiteman, ML. Necrotizing external otitis in patients with AIDS. Laryngoscope 1997;107:456–60CrossRefGoogle ScholarPubMed
8Rubin Grandis, J, Branstetter, BFT, Yu, VL. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis 2004;4:34–9CrossRefGoogle ScholarPubMed
9Keay, DG, Murray, JA. Malignant otitis externa due to staphylococcus infection. J Laryngol Otol 1988;102:926–7CrossRefGoogle ScholarPubMed
10Munoz, A, Martinez-Chamorro, E. Necrotizing external otitis caused by Aspergillus fumigatus: computed tomography and high resolution magnetic resonance imaging in an AIDS patient. J Laryngol Otol 1998;112:98–102CrossRefGoogle Scholar
11Bae, WK, Lee, KS, Park, JW, Bae, EH, Ma, SK, Kim, NH et al. A case of malignant otitis externa caused by Candida glabrata in a patient receiving haemodialysis. Scand J Infect Dis 2007;39:370–2CrossRefGoogle Scholar
12Chai, FC, Auret, K, Christiansen, K, Yuen, PW, Gardam, D. Malignant otitis externa caused by Malassezia sympodialis. Head Neck 2000;22:87–93.0.CO;2-1>CrossRefGoogle ScholarPubMed
13Yang, TH, Kuo, ST, Young, YH. Necrotizing external otitis in a patient caused by Klebsiella pneumoniae. Eur Arch Otorhinolaryngol 2006;263:344–6CrossRefGoogle Scholar
14Benecke, JE Jr.Management of osteomyelitis of the skull base. Laryngoscope 1989;99:1220–3CrossRefGoogle ScholarPubMed
15Stokkel, MP, Boot, CN, van Eck-Smit, BL. SPECT gallium scintigraphy in malignant external otitis: initial staging and follow-up. Laryngoscope 1996;106:338–40CrossRefGoogle ScholarPubMed
16Kwon, BJ, Han, MH, Oh, SH, Song, JJ, Chang, KH. MRI findings and spreading patterns of necrotizing external otitis: is a poor outcome predictable? Clin Radiol 2006;61:495–504CrossRefGoogle ScholarPubMed
17Chandler, JR. Malignant external otitis and facial paralysis. Otolaryngol Clin North Am 1974;7:375–83CrossRefGoogle ScholarPubMed
18Mani, N, Sudhoff, H, Rajagopal, S, Moffat, D, Axon, PR. Cranial nerve involvement in malignant external otitis: implications for clinical outcome. Laryngoscope 2007;117:907–10CrossRefGoogle ScholarPubMed
19Soudry, E, Joshua, BZ, Sulkes, J, Nageris, BI. Characteristics and prognosis of malignant external otitis with facial paralysis. Arch Otolaryngol Head Neck Surg 2007;133:1002–4CrossRefGoogle ScholarPubMed
20Aldous, EW, Shinn, JB. Far advanced malignant external otitis: report of a survival. Laryngoscope 1973;83:1810–15CrossRefGoogle ScholarPubMed
21Evans, IT, Richards, SH. Malignant (necrotising) otitis externa. J Laryngol Otol 1973;87:13–20CrossRefGoogle ScholarPubMed
22Zaky, DA, Bentley, DW, Lowy, K, Betts, RF, Douglas, RG Jr.Malignant external otitis: a severe form of otitis in diabetic patients. Am J Med 1976;61:298–302CrossRefGoogle ScholarPubMed
23Dawson, DA. Malignant otitis externa. J Laryngol Otol 1978;92:803–10CrossRefGoogle ScholarPubMed
24Soliman, AE. A rare case of malignant otitis externa in a non-diabetic patient. J Laryngol Otol 1978;92:811–12CrossRefGoogle Scholar
25Kohut, RI, Lindsay, JR. Necrotizing (“malignant”) external otitis histopathologic processes. Ann Otol Rhinol Laryngol 1979;88:714–20CrossRefGoogle ScholarPubMed
26Raines, JM, Schindler, RA. The surgical management of recalcitrant malignant external otitis. Laryngoscope 1980;90:369–78CrossRefGoogle ScholarPubMed
27Sherman, P, Black, S, Grossman, M. Malignant external otitis due to Pseudomonas aeruginosa in childhood. Pediatrics 1980;66:782–3CrossRefGoogle ScholarPubMed
28Merritt, WT, Bass, JW, Bruhn, FW. Malignant external otitis in an adolescent with diabetes. J Pediatr 1980;96:872–3CrossRefGoogle Scholar
29Ostfeld, E, Aviel, A, Pelet, D. Malignant external otitis: the diagnostic value of bone scintigraphy. Laryngoscope 1981;91:960–4CrossRefGoogle ScholarPubMed
30Obiako, MN. Malignant external otitis: not entirely a disease of the elderly. Practitioner 1981;225:1617–18Google Scholar
31Mader, JT, Love, JT. Malignant external otitis. Cure with adjunctive hyperbaric oxygen therapy. Arch Otolaryngol 1982;108:38–40CrossRefGoogle ScholarPubMed
32Haverkos, HW, Caparosa, R, Yu, VL, Kamerer, D. Moxalactam therapy. Its use in chronic suppurative otitis media and malignant external otitis. Arch Otolaryngol 1982;108:329–33CrossRefGoogle ScholarPubMed
33Reiter, D, Bilaniuk, LT, Zimmerman, RA. Diagnostic imaging in malignant otitis externa. Otolaryngol Head Neck Surg 1982;90:606–9CrossRefGoogle ScholarPubMed
34Shamboul, K, Burns, H. Malignant external otitis in a young diabetic patient. J Laryngol Otol 1983;97:247–9CrossRefGoogle Scholar
35Youngs, R, Bagley, J. Sphenoidal sinusitis secondary to malignant external otitis. J Laryngol Otol 1986;100:341–4CrossRefGoogle ScholarPubMed
36Gherini, SG, Brackmann, DE, Bradley, WG. Magnetic resonance imaging and computerized tomography in malignant external otitis. Laryngoscope 1986;96:542–8CrossRefGoogle ScholarPubMed
37Holder, CD, Gurucharri, M, Bartels, LJ, Colman, MF. Malignant external otitis with optic neuritis. Laryngoscope 1986;96:1021–3CrossRefGoogle ScholarPubMed
38Cunningham, M, Yu, VL, Turner, J, Curtin, H. Necrotizing otitis externa due to Aspergillus in an immunocompetent patient. Arch Otolaryngol Head Neck Surg 1988;114:554–6CrossRefGoogle Scholar
39Morrison, GA, Bailey, CM. Relapsing malignant otitis externa successfully treated with ciprofloxacin. J Laryngol Otol 1988;102:872–6CrossRefGoogle ScholarPubMed
40Osborne, JE, Blair, RL, Davey, P. Successful treatment of malignant otitis externa with oral ciprofloxacin. J Infect 1989;18:298–9CrossRefGoogle ScholarPubMed
41Shupak, A, Greenberg, E, Hardoff, R, Gordon, C, Melamed, Y, Meyer, WS. Hyperbaric oxygenation for necrotizing (malignant) otitis externa. Arch Otolaryngol Head Neck Surg 1989;115:1470–5CrossRefGoogle ScholarPubMed
42Nir, D, Nir, T, Danino, J, Joachims, HZ. Malignant external otitis in an infant. J Laryngol Otol 1990;104:488–90CrossRefGoogle ScholarPubMed
43Barrow, HN, Levenson, MJ. Necrotizing ‘malignant’ external otitis caused by Staphylococcus epidermidis. Arch Otolaryngol Head Neck Surg 1992;118:94–6CrossRefGoogle ScholarPubMed
44Davis, JC, Gates, GA, Lerner, C, Davis, MG Jr, Mader, JT, Dinesman, A. Adjuvant hyperbaric oxygen in malignant external otitis. Arch Otolaryngol Head Neck Surg 1992;118:89–93CrossRefGoogle ScholarPubMed
45Lee, WC, Sharp, JF. Bing-Neel syndrome or malignant external otitis in Waldenstrom's macroglobulinaemia? J Laryngol Otol 1994;108:492–3CrossRefGoogle ScholarPubMed
46Hern, JD, Almeyda, J, Thomas, DM, Main, J, Patel, KS. Malignant otitis externa in HIV and AIDS. J Laryngol Otol 1996;110:770–5CrossRefGoogle ScholarPubMed
47Kountakis, SE, Kemper, JV Jr, Chang, CY, DiMaio, DJ, Stiernberg, CM. Osteomyelitis of the base of the skull secondary to Aspergillus. Am J Otolaryngol 1997;18:19–22CrossRefGoogle ScholarPubMed
48Bath, AP, Rowe, JR, Innes, AJ. Malignant otitis externa with optic neuritis. J Laryngol Otol 1998;112:274–7CrossRefGoogle ScholarPubMed
49Soldati, D, Mudry, A, Monnier, P. Necrotizing otitis externa caused by Staphylococcus epidermidis. Eur Arch Otorhinolaryngol 1999;256:439–41CrossRefGoogle ScholarPubMed
50Paul, AC, Justus, A, Balraj, A, Job, A, Kirubakaran, CP. Malignant otitis externa in an infant with selective IgA deficiency: a case report. Int J Pediatr Otorhinolaryngol 2001;60:141–5CrossRefGoogle Scholar
51Karantanas, AH, Karantzas, G, Katsiva, V, Proikas, K, Sandris, V. CT and MRI in malignant external otitis: a report of four cases. Comput Med Imaging Graph 2003;27:27–34CrossRefGoogle ScholarPubMed
52Shimizu, T, Ishinaga, H, Seno, S, Majima, Y. Malignant external otitis: treatment with prolonged usage of antibiotics and Burow's solution. Auris Nasus Larynx 2005;32:403–6CrossRefGoogle ScholarPubMed
53Singh, A, Al Khabori, M, Hyder, MJ. Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical presentation. Otolaryngol Head Neck Surg 2005;133:121–5CrossRefGoogle ScholarPubMed
54Narozny, W, Kuczkowski, J, Stankiewicz, C, Kot, J, Mikaszewski, B, Przewozny, T. Value of hyperbaric oxygen in bacterial and fungal malignant external otitis treatment. Eur Arch Otorhinolaryngol 2006;263:680–4CrossRefGoogle ScholarPubMed
55Bernstein, JM, Holland, NJ, Porter, GC, Maw, AR. Resistance of pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa. J Laryngol Otol 2007;121:118–23CrossRefGoogle ScholarPubMed
56Mardinger, O, Rosen, D, Minkow, B, Tulzinsky, Z, Ophir, D, Hirshberg, A. Temporomandibular joint involvement in malignant external otitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:398–403CrossRefGoogle ScholarPubMed
57Tuzcu, A, Bahceci, M, Celen, MK, Kilinc, N, Ozmen, S. Necrotizing (malignant) otitis externa: an unusual localization of mucormycosis. Indian J Med Microbiol 2006;24:289–91CrossRefGoogle ScholarPubMed
58Plummer, C, Litewka, L. The march of malignant otitis externa. Intern Med J 2007;37:729–30CrossRefGoogle ScholarPubMed
59Kondziella, D, Skagervik, I. Malignant external otitis with extensive cranial neuropathy but no facial paralysis. J Neurol 2007;254:1298–9CrossRefGoogle ScholarPubMed
60Gattaz, G, Sperotto, LS, Reboucas, LM. Malignant otitis externa. Rev Bras Otorrinolaringol (Engl Ed) 2007;73:134CrossRefGoogle ScholarPubMed
61Fonseca, AS, Andrade, NA, Andrade Neto, ML, Santos, VM. Bilateral hipoglossal nerve palsy in necrotizing otitis externa. Rev Bras Otorrinolaringol (Engl Ed) 2007;73:576CrossRefGoogle ScholarPubMed
62Midwinter, KI, Gill, KS, Spencer, JA, Fraser, ID. Osteomyelitis of the temporomandibular joint in patients with malignant otitis externa. J Laryngol Otol 1999;113:451–3CrossRefGoogle ScholarPubMed
63Patel, SK, McPartlin, DW, Philpott, JM, Abramovich, S. A case of malignant otitis externa following mastoidectomy. J Laryngol Otol 1999;113:1095–7CrossRefGoogle ScholarPubMed
64Lancaster, J, Alderson, DJ, McCormick, M. Non-pseudomonal malignant otitis externa and jugular foramen syndrome secondary to cyclosporin-induced hypertrichosis in a diabetic renal transplant patient. J Laryngol Otol 2000;114:366–9CrossRefGoogle Scholar
65Ismail, H, Hellier, WP, Batty, V. Use of magnetic resonance imaging as the primary imaging modality in the diagnosis and follow-up of malignant external otitis. J Laryngol Otol 2004;118:576–9CrossRefGoogle ScholarPubMed
66Dobbyn, L, O'shea, C, McLoughlin, P. Malignant (invasive) otitis externa involving the temporomandibular joint. J Laryngol Otol 2005;119:61–3CrossRefGoogle ScholarPubMed
67Okpala, NC, Siraj, QH, Nilssen, E, Pringle, M. Radiological and radionuclide investigation of malignant otitis externa. J Laryngol Otol 2005;119:71–5CrossRefGoogle ScholarPubMed
68Shelton, JC, Antonelli, PJ, Hackett, R. Skull base fungal osteomyelitis in an immunocompromised host. Otolaryngol Head Neck Surg 2002;126:76–8CrossRefGoogle Scholar
69Lasisi, OA, Bakare, RA, Usman, MA. Human immunodeficiency virus and invasive external otitis – a case report. West Afr J Med 2003;22:103–5Google ScholarPubMed
70Berenholz, L, Katzenell, U, Harell, M. Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa. Laryngoscope 2002;112:1619–22CrossRefGoogle ScholarPubMed
71Phillips, JS, Jones, SE. Hyperbaric oxygen as an adjuvant treatment for malignant otitis externa. Cochrane Database Syst Rev 2005;(2):CD004617Google ScholarPubMed
72Narozny, W, Kuczkowski, J, Mikaszewski, B. Hyperbaric oxygen to treat malignant external otitis. Am Fam Physician 2004;70:1860Google ScholarPubMed