Sudhoff Holger, Rajagopal Sandeep, Mani Navin, Moumoulidis Ioannis, Axon Patrick R, Moffat David
Department of Otolaryngology and Skull Base Surgery, Addenbrooke's Hospital, Cambridge, UK.
Eur Arch Otorhinolaryngol. 2008 Jan;265(1):53-6. doi: 10.1007/s00405-007-0416-8. Epub 2007 Aug 7.
Computerized tomography (CT) scanning is a well recognised tool for the diagnosis of malignant external otitis. To investigate the degree of correlation between CT findings scan and the patients clinical status focusing on a subgroup of patients with cranial nerve palsies. Diagnosis of malignant external otitis was confirmed in 23 patients (average age 71 years, age range 39-87) based on criteria of severe pain, otitis externa refractory to conventional treatments and possibly diabetes mellitus and pseudomonas detection. CT was performed on 23 of these patients. Results from these scans were analysed and correlated with patient clinical status. Retrospective analysis of CT images and medical notes were used for data analysis.The CT scans of all 23 patients showed evidence of involvement of disease outside the external auditory canal, confirming the diagnosis. Sixteen out of 23 patients (70%) demonstrated evidence of bone erosion. Four of the 16 showed involvement of the petrous apex. From our subset of ten patients with cranial nerve involvement, eight demonstrated evidence of bone erosion and two showed mastoid and middle ear involvement without bone erosion. All four patients with petrous apical involvement presented with cranial nerve palsies (two lower cranial nerve palsies, one seventh nerve palsy and one combined lower and seventh nerve palsy). CT scanning was found to be a fast and economical tool in the initial assessment of patients with malignant external otitis. Petrous apex involvement was constantly associated with cranial nerve palsies, usually the lower cranial nerves. CT findings of temporal bone in itself however, were not closely correlated to the clinical outcome of the patients.
计算机断层扫描(CT)是诊断恶性外耳道炎的一种公认的工具。本研究聚焦于一组患有颅神经麻痹的患者,旨在调查CT扫描结果与患者临床状况之间的关联程度。根据严重疼痛、常规治疗无效的外耳道炎以及可能存在的糖尿病和铜绿假单胞菌检测标准,确诊了23例恶性外耳道炎患者(平均年龄71岁,年龄范围39 - 87岁)。对其中23例患者进行了CT检查。分析这些扫描结果,并将其与患者的临床状况进行关联。通过对CT图像和病历的回顾性分析进行数据分析。所有23例患者的CT扫描均显示外耳道外有疾病累及的证据,从而确诊。23例患者中有16例(70%)显示有骨质侵蚀的证据。16例中的4例显示岩尖受累。在我们的10例颅神经受累患者亚组中,8例显示有骨质侵蚀的证据,2例显示乳突和中耳受累但无骨质侵蚀。所有4例岩尖受累患者均出现颅神经麻痹(2例为低位颅神经麻痹,1例为第七颅神经麻痹,1例为低位和第七颅神经联合麻痹)。结果发现,CT扫描是恶性外耳道炎患者初始评估中一种快速且经济的工具。岩尖受累常与颅神经麻痹相关,通常是低位颅神经。然而,颞骨本身的CT表现与患者的临床结局并无密切关联。