Necrotizing external otitisNecrotiz

Necrotizing external otitis
Necrotizing external otitis (malignant otitis externa) is an uncommon form of external otitis occurs mainly in elderly diabetics, being somewhat more likely and more severe when the diabetes is poorly controlled. Even less commonly, it can develop due to a severely compromised immune system. Beginning as infection of the external ear canal, there is extension of infection into the bony ear canal and the soft tissues deep to the bony canal. The hallmark of malignant otitis externa (MOE) is unrelenting pain that interferes with sleep and persists even after swelling of the external ear canal may have resolved with topical antibiotic treatment.

Natural history
MOE follows a much more chronic and indolent course than ordinary acute otitis externa. There may be granulation involving the floor of the external ear canal, most often at the bony-cartilaginous junction. Paradoxically, the physical findings of MOE, at least in its early stages, are often much less dramatic than those of ordinary acute otitis externa. In later stages there can be soft tissue swelling around the ear, even in the absence of significant canal swelling. While fever and leukocytosis might be expected in response to bacterial infection invading the skull region, MOE does not cause fever or elevation of white blood count.

Treatment of MOE
Unlike ordinary otitis externa, MOE requires oral or intravenous antibiotics for cure. Diabetes control is also an essential part of treatment. When MOE goes unrecognized and untreated, the infection continues to smolder and over weeks or months can spread deeper into the head and involve the bones of the skull base, constituting skull base osteomyelitis (SBO). The infecting organism is almost always pseudomonas aeruginosa, but it can instead be fungal (aspergillus or mucor). MOE and SBO are not amenable to surgery, but exploratory surgery may facilitate culture of unusual organism(s) that are not responding to empirically used anti-pseudomonal antibiotics. The usual surgical finding is diffuse cellulitis without localized abscess formation. SBO can extend into the petrous apex of the temporal bone or more inferiorly into the opposite side of the skull base.

Complications
As the skull base is progressively involved, the adjacent exiting cranial nerves and their branches, especially the facial nerve and the vagus nerve, may be affected, resulting in facial paralysis and hoarseness, respectively. If both of the recurrent laryngeal nerves are paralyzed, shortness of breath may develop and necessitate tracheotomy. Profound deafness can occur, usually later in the disease course due to relative resistance of the inner ear structures. Gallium scans are sometimes used to document the extent of the infection but are not essential to disease management. Skull base osteomyelitis is a chronic disease that can require months of IV antibiotic treatment, tends to recur, and has a significant mortality rate.

Epidemiology

The incidence of otitis externa is high. In the Netherlands, it has been estimated at 12–14 per 1000 population per year, and has been shown to affect more than 1% of a sample of the population in the United Kingdom over a 12 month period.[13]

Hasil (Bahasa Indonesia) 1:

Necrotizing otitis eksternalNecrotizing eksternal otitis (otitis ganas eksterna) adalah bentuk otitis eksternal yang jarang terjadi terutama pada penderita diabetes tua, menjadi agak lebih kemungkinan dan lebih parah ketika diabetes tidak terkontrol. Bahkan kurang umum, itu dapat mengembangkan karena sebuah sistem kekebalan dikompromikan parah. Dimulai sebagai infeksi telinga eksternal kanal, ada ekstensi infeksi tulang telinga kanal dan jaringan lunak yang mendalam ke kanal tulang. Ciri khas ganas otitis eksterna (MOE) adalah nyeri tak henti-hentinya yang mengganggu tidur dan tetap ada bahkan setelah pembengkakan saluran telinga eksternal mungkin telah diselesaikan dengan pengobatan antibiotik topikal.Sejarah AlamMOE mengikuti kursus lebih kronis dan malas daripada eksterna otitis akut biasa. Mungkin ada granulasi melibatkan lantai saluran telinga eksternal, paling sering di persimpangan tulang-tulang rawan. Paradoksnya, temuan-temuan fisik MOE, setidaknya dalam tahap awal, sering jauh lebih dramatis daripada eksterna otitis akut biasa. Dalam tahap selanjutnya ada pembengkakan di sekitar telinga, bahkan dalam ketiadaan signifikan kanal pembengkakan jaringan lembut. Sementara demam dan leukocytosis mungkin diharapkan dalam menanggapi infeksi bakteri yang menyerang wilayah tengkorak, MOE tidak menyebabkan demam atau elevasi putih hitung darah.Pengobatan MOEUnlike ordinary otitis externa, MOE requires oral or intravenous antibiotics for cure. Diabetes control is also an essential part of treatment. When MOE goes unrecognized and untreated, the infection continues to smolder and over weeks or months can spread deeper into the head and involve the bones of the skull base, constituting skull base osteomyelitis (SBO). The infecting organism is almost always pseudomonas aeruginosa, but it can instead be fungal (aspergillus or mucor). MOE and SBO are not amenable to surgery, but exploratory surgery may facilitate culture of unusual organism(s) that are not responding to empirically used anti-pseudomonal antibiotics. The usual surgical finding is diffuse cellulitis without localized abscess formation. SBO can extend into the petrous apex of the temporal bone or more inferiorly into the opposite side of the skull base.ComplicationsAs the skull base is progressively involved, the adjacent exiting cranial nerves and their branches, especially the facial nerve and the vagus nerve, may be affected, resulting in facial paralysis and hoarseness, respectively. If both of the recurrent laryngeal nerves are paralyzed, shortness of breath may develop and necessitate tracheotomy. Profound deafness can occur, usually later in the disease course due to relative resistance of the inner ear structures. Gallium scans are sometimes used to document the extent of the infection but are not essential to disease management. Skull base osteomyelitis is a chronic disease that can require months of IV antibiotic treatment, tends to recur, and has a significant mortality rate.EpidemiologyThe incidence of otitis externa is high. In the Netherlands, it has been estimated at 12–14 per 1000 population per year, and has been shown to affect more than 1% of a sample of the population in the United Kingdom over a 12 month period.[13]