Hasibi Mehrdad, Ashtiani Mohammadtaghi Khorsandi, Motassadi Zarandi Masoud, Yazdani Nasrin, Borghei Pedram, Kuhi Ali, Dabiri Sasan, Hosseini Reza, Sardashti Sara
1 Amir-Alam Hospital, Tehran, Iran, Islamic Republic Of.
2 Tehran University of Medical Sciences Department and Research Center of Otolaryngology Head and Neck Surgery, Tehran, Iran, Islamic Republic Of.
Ann Otol Rhinol Laryngol. 2017 Jul;126(7):561-567. doi: 10.1177/0003489417710473. Epub 2017 May 21.
High rates of negative microbiologic test results highlight the potential role of empiric antimicrobial agents in management of malignant otitis externa (MOE). This study investigates the clinical presentation, laboratory findings, and response to empiric treatment in a large group of patients admitted to a tertiary academic hospital in Tehran, Iran.
We recruited 224 patients diagnosed with MOE in a prospective observation from 2009 through 2015. All patients received a 2-agent antibacterial regimen at baseline (phase I). Patients with no improvement within 10 days and/or nonresponders to a second course of antibacterials were switched to antifungals (phase II). Response to treatment was observed and documented in both groups.
All patients had physical symptoms for more than 12 weeks before admission. In total, 127 patients responded well to antibacterials. Eighty-seven out of 97 patients who were switched to antifungals had complete response to treatment; patients in the latter group had significantly higher A1C levels at baseline.
Our findings provide evidence to develop clinical guidelines that accelerate diagnosis and treatment of MOE to improve patient outcomes.
微生物检测结果阴性的高比例凸显了经验性抗菌药物在恶性外耳道炎（MOE）治疗中的潜在作用。本研究调查了伊朗德黑兰一家三级学术医院收治的一大组患者的临床表现、实验室检查结果以及对经验性治疗的反应。
我们在2009年至2015年期间进行了一项前瞻性观察研究，招募了224例被诊断为MOE的患者。所有患者在基线期（第一阶段）接受双药抗菌治疗方案。在10天内无改善和/或对抗菌药物第二疗程无反应的患者改用抗真菌药物（第二阶段）。观察并记录两组患者的治疗反应。
所有患者在入院前均有超过12周的身体症状。总共有127例患者对抗菌药物反应良好。改用抗真菌药物的97例患者中有87例对治疗完全反应；后一组患者在基线时的糖化血红蛋白水平显著更高。
我们的研究结果为制定临床指南提供了证据，以加速MOE的诊断和治疗，改善患者预后。
