Otolaryngology-Head and Neck Surgery (ENT), National University Hospital, Singapore.
Otolaryngol Head Neck Surg. 2013 Jun;148(6):991-6. doi: 10.1177/0194599813482107. Epub 2013 Apr 4.
Malignant otitis externa (MOE) is a severe disease with varying outcomes. Despite advances in antibiotic treatment, a significant proportion still succumbs to this disease. We aimed to analyze the effect of clinical factors on prognosis and to review treatment outcomes in our institution.
Case series with retrospective chart review of MOE cases from 2006 to 2011.
Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore, a tertiary referral center.
Patients with MOE admitted for treatment were studied and divided into 2 outcome groups depending on response to a 6-week course of intravenous antibiotics. Demographic and disease factors were analyzed with regard to outcome.
Nineteen cases were analyzed. Disease resolved in 63.2% after 6 weeks of antibiotics. Mortality was 21.1%. Age, diabetic control, duration of diagnostic delay, cranial nerve involvement, and inflammatory markers were not found to predict prognosis. Erythrocyte sedimentation rate and C-reactive protein levels correlated with disease activity and can be used to monitor progress. Clival involvement was associated with persistent disease (P = .002). Only 63.2% of cases had positive cultures. Pseudomonas aeruginosa was the main organism, and 33.3% of isolates were multidrug resistant. Outcome was not different in cases where culture-directed therapy was employed vs those where empirical ceftazidime and fluoroquinolone were used (P = .650).
Malignant otitis externa remains an insidious disease with significant mortality. Involvement of the clivus portends a poorer prognosis. Combination therapy with intravenous ceftazidime and oral fluoroquinolone remains relevant despite concerns of culture-negative cases and multidrug-resistant Pseudomonas.
恶性外耳道炎（MOE）是一种预后差异较大的严重疾病。尽管抗生素治疗有所进展，但仍有相当一部分患者死于该病。本研究旨在分析临床因素对预后的影响，并回顾我院的治疗结果。
2006 年至 2011 年 MOE 病例的回顾性病例系列研究。
新加坡国立大学医院耳鼻喉科头颈外科，一家三级转诊中心。
研究纳入因 MOE 入院治疗的患者，并根据 6 周静脉抗生素疗程的反应将其分为两组。分析与预后相关的人口统计学和疾病因素。
共分析了 19 例患者。6 周抗生素治疗后，63.2%的患者病情缓解。死亡率为 21.1%。年龄、糖尿病控制、诊断延迟时间、颅神经受累以及炎症标志物均不能预测预后。红细胞沉降率和 C 反应蛋白水平与疾病活动相关，可用于监测进展。颅底受累与疾病持续存在相关（P=0.002）。仅 63.2%的病例培养阳性。铜绿假单胞菌是主要病原体，33.3%的分离株为多重耐药菌。采用靶向培养的治疗方案与采用经验性头孢他啶和氟喹诺酮治疗的患者的预后无差异（P=0.650）。
恶性外耳道炎仍是一种隐匿性疾病，死亡率较高。颅底受累预示预后不良。尽管存在培养阴性病例和多重耐药铜绿假单胞菌的问题，静脉用头孢他啶联合口服氟喹诺酮的联合治疗仍然有效。
