Yeheskeli E, Eta R Abu, Gavriel H, Kleid S, Eviatar E
Department of Otolaryngology Head and Neck Surgery,Assaf Harofeh Medical Center,Zerifin,affiliated to the Sackler Faculty of Medicine,Tel Aviv University,Israel.
Department of Surgical Oncology,Peter MacCallum Cancer Institute,Melbourne,Australia.
J Laryngol Otol. 2016 May;130(5):435-9. doi: 10.1017/S0022215116000323. Epub 2016 Mar 15.
Necrotising otitis externa is associated with high morbidity and mortality rates. This study investigated whether temporomandibular joint involvement had any prognostic effect on the course of necrotising otitis externa in patients who had undergone hyperbaric oxygen therapy after failed medical and sometimes surgical therapy.
A retrospective case series was conducted of patients in whom antibiotic treatment and surgery had failed, who had been hospitalised for further treatment and hyperbaric oxygen therapy.
Twenty-three patients with necrotising otitis externa were identified. The temporomandibular joint was involved in four patients (17 per cent); these patients showed a constant gradual improvement in C-reactive protein and were eventually discharged free of disease, except one patient who was lost to follow up. Four patients (16 per cent) without temporomandibular joint involvement died within 90 days of discharge, while all patients with temporomandibular joint involvement were alive. Three patients (13 per cent) without temporomandibular joint involvement needed recurrent hospitalisation including further hyperbaric oxygen therapy; no patients with temporomandibular joint involvement required such treatment.
Patients with temporomandibular joint involvement had lower rates of recurrent disease and no mortality. Therefore, we suggest considering temporomandibular joint involvement as a positive prognostic factor in necrotising otitis externa management.
坏死性外耳道炎与高发病率和死亡率相关。本研究调查了在药物治疗甚至手术治疗失败后接受高压氧治疗的患者中，颞下颌关节受累对坏死性外耳道炎病程是否有任何预后影响。
对药物治疗和手术治疗失败、因进一步治疗和高压氧治疗而住院的患者进行回顾性病例系列研究。
确定了23例坏死性外耳道炎患者。4例患者（17%）颞下颌关节受累；这些患者的C反应蛋白持续逐渐改善，除1例失访患者外，最终均治愈出院。4例（16%）未累及颞下颌关节的患者在出院后90天内死亡，而所有累及颞下颌关节的患者均存活。3例（13%）未累及颞下颌关节的患者需要再次住院，包括进一步进行高压氧治疗；而累及颞下颌关节的患者均无需此类治疗。
累及颞下颌关节的患者疾病复发率较低且无死亡病例。因此，我们建议将颞下颌关节受累视为坏死性外耳道炎治疗中的一个积极预后因素。
