Joshua Ben Zion, Sulkes Jaqueline, Raveh Eyal, Bishara Jihad, Nageris Ben I
Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel.
Otol Neurotol. 2008 Apr;29(3):339-43. doi: 10.1097/MAO.0b013e3181661879.
Malignant external otitis (MEO) continues to pose a diagnostic and therapeutic challenge. The lack of a diagnostic study since 1987 combined with recent findings of quinolone-resistant MEO prompted the present analysis of MEO outcome in a major tertiary medical center.
Seventy-five consecutive patients hospitalized for suspected MEO between 1990 and 2003 were divided into 2 diagnostic groups: MEO Type 1, presence of all obligatory clinical and radiologic criteria and most of the occasional criteria of Cohen and Friedman or absence of 1 obligatory criterion with failure of intensive treatment, and MEO Type 2, absence of one of the obligatory criteria with treatment response within 1 week. The groups were compared for demographic data, underlying diseases, ear parameters, culture findings, length of hospitalization, and treatment before hospitalization, obtained from the charts.
Both types of MEO affected mostly diabetic patients and were characterized by granulations and discharge in the external ear, severe prolonged pain, soft tissue involvement and bone destruction on computed tomographic scan, and growth of Pseudomonas aeruginosa in culture. However, Type 1 MEO was associated with a significantly older patient age at presentation, higher rate of oral antidiabetic treatment, history of diabetic (vascular) complications, computed tomographic findings of nasopharyngeal involvement (soft tissue swelling, soft tissue asymmetry, or abscess formation), bone destruction, and temporomandibular joint involvement-all of which led to significantly longer treatment and shorter survival.
The worse prognosis of Type 1 MEO compared with Type 2 should alert clinicians to establish earlier diagnosis and treatment.
恶性外耳道炎（MEO）仍然是一个诊断和治疗上的挑战。自1987年以来缺乏诊断性研究，再加上近期耐喹诺酮类MEO的研究结果，促使我们在一家大型三级医疗中心对MEO的治疗结果进行了本次分析。
1990年至2003年间，75例因疑似MEO住院的连续患者被分为2个诊断组：MEO 1型，具备所有必需的临床和影像学标准以及科恩和弗里德曼提出的大多数偶发标准，或缺乏1项必需标准且强化治疗失败；MEO 2型，缺乏1项必需标准但在1周内治疗有效。从病历中获取两组患者的人口统计学数据、基础疾病、耳部参数、培养结果、住院时间以及住院前的治疗情况，并进行比较。
两种类型的MEO主要影响糖尿病患者，其特征为外耳道有肉芽和分泌物、严重的持续性疼痛、软组织受累以及计算机断层扫描显示的骨质破坏，培养结果显示铜绿假单胞菌生长。然而，MEO 1型患者就诊时年龄显著更大，口服抗糖尿病治疗率更高，有糖尿病（血管）并发症史，计算机断层扫描显示鼻咽部受累（软组织肿胀、软组织不对称或脓肿形成）、骨质破坏以及颞下颌关节受累，所有这些均导致治疗时间显著延长且生存期缩短。
与MEO 2型相比，MEO 1型预后较差，这应提醒临床医生更早地进行诊断和治疗。
