The association between radiological spreading pattern and clinical outcomes in necrotizing external otitis

• Published in: Journal of otology (Beijing) Vol. 17; no. 3; pp. 156 - 163
• Main Authors: Leentje van der Meer, W., Bayoumy, Ahmed B., Otten, Josje J., Waterval, Jerome J., Kunst, Henricus P.M., Postma, Alida A.
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.07.2022; Dutch Academic Alliance Skull Base Pathology,Maastricht University Medical Center+,Radboud University Medical Center,Maastricht/Nijmegen,the Netherlands; Department of Radiology & Nuclear Medicine,Maastricht University Medical Center,the Netherlands; School for Mental Health & Neuroscience,Maastricht University,Maastricht,the Netherlands; Dutch Academic Alliance Skull Base Pathology,Maastricht University Medical Center+,Radboud University Medical Center,Maastricht/Nijmegen,the Netherlands%Department of Otorhinolaryngology and Head and Neck Surgery,Maastricht University Medical Center,the Netherlands; Department of Otorhinolaryngology and Head and Neck Surgery,Radboud Institute for Health Sciences,Radboud University Medical Center,the Netherlands; Dutch Academic Alliance Skull Base Pathology,Maastricht University Medical Center+,Radboud University Medical Center,Maastricht/Nijmegen,the Netherlands%Department of Radiology & Nuclear Medicine,Maastricht University Medical Center,the Netherlands; Chinese PLA General Hospital; Tsinghua University Press
• Subjects: Antibiotic exposure; Clinical manifestation; facial nerve palsy; Malignant external otitis; Necrotizing external otitis; Skull base osteomyelitis; Spreading routes; facial nerve palsy; malignant external otitis; necrotizing external otitis; skull base osteomyelitis; clinical manifestation; spreading routes; antibiotic exposure; Clinical manifestation; Necrotizing external otitis; Antibiotic exposure; Skull base osteomyelitis; Spreading routes; Malignant external otitis; Facial nerve palsy
• ISSN: 1672-2930; 2524-1753
• DOI: 10.1016/j.joto.2022.05.002

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 2010-2019 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