Franco-Vidal Valerie, Blanchet Harold, Bebear Cécile, Dutronc Hervé, Darrouzet Vincent
Otolaryngology and Skull Base Surgery Department, Pellegrin Hospital, France.
Otol Neurotol. 2007 Sep;28(6):771-3. doi: 10.1097/MAO.0b013e31805153bd.
To define germs involved, clinical presentation, treatment regimen, and prognostic factors in necrotizing external otitis.
Retrospective study reviewing a series of 46 patients treated during 10 years in a tertiary care center. Diagnosis was confirmed by using otomicroscopy, computed tomographic and/or magnetic resonance imaging scan and bone scintigraphy (Te 99 and Ga 26 bone scan). Patients were provided ceftazidime and ciprofloxacin intravenously and monitored using a Ga-67 bone scan. The following were assessed: presenting symptoms, general context, bacteriological analysis, imaging protocol sensitivity, complications, delay to healing, and cure rate.
Sex ratio was 2.29 (mean age, 73.6 yr). The most common presenting symptoms were otalgia and otorrhea in 97.8 and 91.3%, respectively. Facial paralysis was present in 19.6% of cases. Thirty patients had diabetes mellitus (65.2%), and 8 were immunocompromised (17.4%). Pseudomonas aeruginosa was isolated in 69.2% of cases and was resistant to ciprofloxacin in 18.5%, but was susceptible to ceftazidime in all cases. Four patients died during the treatment (4.4%), but only 2 of disease. The mean delay to healing was 14 weeks (SD, 9.7). Healing rate was 95.6%. No relapse was observed after a mean follow-up of 78.4 weeks (SD, 36.5 wks). Two factors significantly influenced the prognosis: facial paralysis and existence of systemic factors for immune deficiency (p = 0.023 and 0.038, respectively).
The association of ciprofloxacin and ceftazidime was efficient in countering the increasing resistance of P. aeruginosa to quinolones. We propose a prognostic classification of necrotizing external otitis based on the presence of facial paralysis and/or systemic factors.
明确坏死性外耳道炎所涉及的病原体、临床表现、治疗方案及预后因素。
回顾性研究，对一家三级医疗中心10年间治疗的46例患者进行分析。通过耳显微镜检查、计算机断层扫描和/或磁共振成像扫描以及骨闪烁显像（锝99和镓67骨扫描）确诊。患者接受静脉注射头孢他啶和环丙沙星治疗，并使用镓67骨扫描进行监测。评估以下内容：首发症状、总体情况、细菌学分析、影像检查方案的敏感性、并发症、愈合延迟情况及治愈率。
男女比例为2.29（平均年龄73.6岁）。最常见的首发症状分别为耳痛（97.8%）和耳漏（91.3%）。19.6%的病例出现面瘫。30例患者患有糖尿病（65.2%），8例免疫功能低下（17.4%）。69.2%的病例分离出铜绿假单胞菌，其中18.5%对环丙沙星耐药，但对头孢他啶均敏感。4例患者在治疗期间死亡（4.4%），但仅2例死于该病。平均愈合延迟时间为14周（标准差9.7）。治愈率为95.6%。平均随访78.4周（标准差36.5周）后未观察到复发。两个因素对预后有显著影响：面瘫和存在免疫缺陷的全身因素（p值分别为0.023和0.038）。
环丙沙星和头孢他啶联合使用能有效应对铜绿假单胞菌对喹诺酮类药物日益增加的耐药性。我们基于面瘫和/或全身因素的存在提出了坏死性外耳道炎的预后分类。
