ENT Department, Habib Thameur Hospital, Tunis, Tunisia.
Eur Arch Otorhinolaryngol. 2010 Aug;267(8):1193-8. doi: 10.1007/s00405-009-1194-2. Epub 2010 Jan 8.
Necrotizing otitis externa is an uncommon but severe infectious disease of the external auditory canal. Patients at risk are those immunodepressed or having diabetes. The causal germ is often Pseudomonas aeruginosa. Over a period of 10 years (1997-2006), we treated 19 patients: 94.7% had diabetes (insulin dependent in 6 cases). The causal germ was P. aeruginosa in 59% of cases. The pretherapeutic work-up included a computed tomography and a scintigraphy practiced in order to confirm diagnosis and assess the extension. Medical treatment was based on a parenteral antibiotic therapy using a third-generation cephalosporin and a fluoroquinolones. Local treatment of the auditory canal including cleaning and application of antimicrobial agents was performed in all the cases. Surgical debridement of soft tissue and infected bone was performed in one patient who did not respond to medical management. Repeated scintigraphies with gallium were used to follow the course under treatment in only three cases. We had a 89.4% cure rate with only three cases of recurrence. We reviewed the data in the literature on necrotizing otitis externa and present the important diagnostic, imaging, and therapeutic aspects of the disease.
坏死性外耳道炎是一种罕见但严重的外耳道感染性疾病。易患人群为免疫功能低下或患有糖尿病的患者。致病细菌通常是铜绿假单胞菌。在 10 年期间（1997-2006 年），我们治疗了 19 例患者：94.7%有糖尿病（6 例为胰岛素依赖型）。59%的病例致病细菌为铜绿假单胞菌。治疗前的检查包括 CT 和闪烁扫描，以确认诊断并评估病变范围。治疗基于第三代头孢菌素和氟喹诺酮类药物的全身抗生素治疗。所有患者均进行了外耳道的局部清洁和抗菌药物治疗。1 例患者对药物治疗无反应，行软组织和感染骨的外科清创术。仅在 3 例患者中使用镓重复闪烁扫描来观察治疗过程中的病情。我们的治愈率为 89.4%，仅 3 例复发。我们回顾了坏死性外耳道炎的文献数据，并介绍了该疾病的重要诊断、影像学和治疗方面。
