Malignant Otitis Externa: A Novel Stratification Protocol for Predicting Treatment Outcomes.

Document Type

Article

Abstract

OBJECTIVES: 1) Stratify malignant otitis externa into severe and nonsevere disease categories. 2) Predict treatment courses and outcomes based on this stratification.

SETTING: Tertiary center.

PATIENTS: Retrospective review 2004 to 2014; 28 patients. Inclusion criteria are a diagnosis by senior authors, radiographic evidence of disease, admission for intravenous antibiotics/debridement, minimum 1 year of follow-up.

INTERVENTIONS: Severe group stratification if two or more of the following: cranial nerve VII palsy, fungal positive culture, relapse, surgery performed, major radiographic findings. All other patients stratified to nonsevere group.

MAIN OUTCOME MEASURES: Cure, alive/refractory disease, death by disease, death by other cause. Secondary measures are antibiotic duration and number of disease-related admissions.

RESULTS: Forty-three percent (12 of 28) and 57% (16 of 28) of patients stratified into the severe and nonsevere groups. The severe group had significantly more adverse disease-specific outcomes than the nonsevere group (7 of 12 versus 0 of 16; p = 0.002). Disease-specific mortality was 42% and 0% in the severe and nonsevere groups, respectively. The severe group had longer antibiotic courses (12.8 versus 6.9 wk; p = 0.01) and more disease-related admissions/relapses (1.6 versus 1, p < 0.001). Only four of 12 severe group patients achieved cure. All but two nonsevere patients achieved cure, with those two dying of other causes.

CONCLUSION: A subgroup of malignant otitis externa may exist that is not as susceptible to parenteral antibiotics and local debridement. A combination of clinical and radiographic findings may be useful for stratifying patients into severe/nonsevere categories. Patients with severe disease may be more likely to die of their disease and have worse treatment courses such that additional surgical intervention may be indicated.

Medical Subject Headings

Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Aspergillosis; Chronic Disease; Debridement; Diabetes Complications; Diabetes Mellitus; Disease Progression; Escherichia coli Infections; Facial Nerve Diseases; Female; Hospitalization; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Osteomyelitis; Otitis Externa; Pseudomonas Infections; Recurrence; Retrospective Studies; Severity of Illness Index; Staphylococcal Infections; Tomography, X-Ray Computed; Treatment Outcome

Publication Date

9-1-2015

Publication Title

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology

ISSN

1537-4505

Volume

36

Issue

9

First Page

1492

Last Page

1498

PubMed ID

26375971

Digital Object Identifier (DOI)

10.1097/MAO.0000000000000839

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