van der Meer W Leentje, Bayoumy Ahmed B, Otten Josje J, Waterval Jerome J, Kunst Henricus P M, Postma Alida A
Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, the Netherlands.
Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center+, Radboud University Medical Center, Maastricht/Nijmegen, the Netherlands.
J Otol. 2022 Jul;17(3):156-163. doi: 10.1016/j.joto.2022.05.002. Epub 2022 Jun 3.
Necrotizing external otitis (NEO) is a rare infectious disease of the skull base. The purpose of this study was to determine whether clinical outcomes of NEO can be correlated to different infectious spread patterns.
Retrospective chart review from 2010 to 2019 with NEO patients, who were divided into two cohorts: single spreading patterns (group A) or complex spreading patterns (group B) as diagnosed by CT. Clinical symptoms, diagnostic and treatment delay, course of disease, complications, and duration of antibiotic exposure were retrospectively collected from patient records.
41 NEO patients were included, of which 27 patients belonged to group A (66%). The disease-related mortality rate was 12.2% among the entire cohort, no differences were found between group A and B. Higher rates of N.VII (42.9% vs 14.8% P = 0.047) and N. IX palsies were found in group B compared to group A (28.6% vs 3.7%, P = 0.039). The median duration of antibiotic use was significantly different for a complex spreading pattern, clinical recovery and hospitalizations. Complications were associated with higher diagnostic delay and with a complex spread pattern. The median duration of follow-up was 12.0 (IQR 6.0-19.5) months.
NEO is a severe disease, with significant mortality and morbidity (cranial nerve palsies). The radiological spread pattern may assist in predicting clinical outcome. Furthermore, complex spread patterns are associated with higher rates of clinical nerve palsies (N. VII and N.IX), complications, surgery rates and longer duration of antibiotic use. Diagnostic delay was associated with mortality, complications and facial palsies.
Level IV.
坏死性外耳道炎（NEO）是一种罕见的颅底感染性疾病。本研究的目的是确定NEO的临床结局是否与不同的感染扩散模式相关。
对2010年至2０19年的NEO患者进行回顾性病历审查，这些患者被分为两个队列：根据CT诊断为单一扩散模式（A组）或复杂扩散模式（B组）。从患者记录中回顾性收集临床症状、诊断和治疗延迟、病程、并发症以及抗生素暴露持续时间。
纳入41例NEO患者，其中27例属于A组（66%）。整个队列的疾病相关死亡率为12.2%，A组和B组之间未发现差异。与A组相比，B组的面神经麻痹（42.9%对14.8%，P = 0.047）和舌咽神经麻痹发生率更高（28.6%对3.7%，P = 0 .039）。复杂扩散模式、临床恢复和住院的抗生素使用中位持续时间有显著差异。并发症与更高的诊断延迟和复杂扩散模式相关。中位随访时间为12.0（IQR 6.0-19.5）个月。
NEO是一种严重疾病，具有显著的死亡率和发病率（颅神经麻痹）。放射学扩散模式可能有助于预测临床结局。此外，复杂扩散模式与更高的临床神经麻痹（面神经和舌咽神经）发生率、并发症、手术率以及更长的抗生素使用持续时间相关。诊断延迟与死亡率、并发症和面瘫相关。
四级
