Departments of Oto-Rhino-Laryngology, University Hospital of Reims, Rue du Général Koenig, 51100, Reims, France.
Department of Internal Medicine, Infectious Diseases and Clinical Immunology, University Hospital of Reims, Reims, France.
Eur Arch Otorhinolaryngol. 2024 May;281(5):2383-2394. doi: 10.1007/s00405-024-08549-5. Epub 2024 Mar 18.
Necrotizing otitis externa (OEN) is an aggressive and morbid infection of the external acoustic meatus. What are the risk factors for OEN extension?
French monocentric retrospective study (2004-2021), including patients with OEN defined by the association of an inflamed EAM, a positive nuclear imaging, the presence of a bacteriological sample and the failure of a well-followed local and/or general antibiotic treatment. OEN was extensive if it was associated with vascular or neurological deficits, if nuclear imaging fixation and/or bone lysis extended beyond the tympanic bone.
Our population (n = 39) was male (74%), type 2 diabetic (72%), aged 75.2 years and pseudomonas aeruginosa was found in 88% of cases. Complications for 43% of patients were extensive fixation on nuclear imaging, for 21% of them the presence of extensive bone lysis, for 13% the appearance of facial palsy, for 5.3% the presence hypoglossal nerve palsy and for 2.5% the presence of thrombophlebitis or other nerves palsies. 59% of our population had extensive OEN. The diagnosis of the extensive OEN was made 22 days later (p = 0.04). The clinical presentation was falsely reassuring due to easier identification of the tympanic membrane (70% vs 46%, p = 0.17) but associated with periauricular oedema (42% vs 0%), bone exposure (16% vs 0%) and a temporomandibular joint pain (41% vs 12%).
Delayed treatment of OEN, identification of clinical bone lysis, especially when the tympanic membrane is easily visualized, and the presence of unbalanced diabetes are potential risk factors for extension of OEN.
坏死性外耳道炎（OEN）是外耳道的一种侵袭性和恶性感染。OEN 扩展的危险因素有哪些？
法国单中心回顾性研究（2004-2021 年），纳入 OEN 患者，定义为外耳道炎伴炎症、核成像阳性、有细菌学样本和经过适当随访的局部和/或全身抗生素治疗失败。如果 OEN 伴有血管或神经缺损、核成像固定和/或骨溶解超出鼓膜骨、则为广泛 OEN。
我们的患者人群（n=39）中，男性占 74%，2 型糖尿病占 72%，年龄为 75.2 岁，88%的病例中发现铜绿假单胞菌。43%的患者出现核成像广泛固定，21%的患者出现广泛骨溶解，13%的患者出现面瘫，5.3%的患者出现舌下神经麻痹，2.5%的患者出现血栓性静脉炎或其他神经麻痹。59%的患者出现广泛 OEN。广泛 OEN 的诊断延迟了 22 天（p=0.04）。由于更容易识别鼓膜（70%比 46%，p=0.17），临床表现被错误地认为是安全的，但与耳周水肿（42%比 0%）、骨暴露（16%比 0%）和颞下颌关节疼痛（41%比 12%）有关。
OEN 治疗延迟、识别临床骨溶解，尤其是当鼓膜容易观察到、以及糖尿病不平衡是 OEN 扩展的潜在危险因素。
