Analysis of Prognostic Factors in Malignant External Otitis
#MMPMID27671716
Lee SK
; Lee SA
; Seon SW
; Jung JH
; Lee JD
; Choi JY
; Kim BG
Clin Exp Otorhinolaryngol
2017[Sep]; 10
(3
): 228-235
PMID27671716
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OBJECTIVES: Malignant external otitis (MEO) is a potentially fatal infection of
the external auditory canal, temporal bone, and skull base. Despite treatment
with modern antibiotics, MEO can lead to skull base osteomyelitis. Until now,
there have been few studies on the prognostic factors of MEO. METHODS: We
performed a retrospective study to identify prognostic factors of MEO, and a
meta-analysis of other articles investigating MEO. On the basis of disease
progression the 28 patients in our study were divided into 'controlled' and
'uncontrolled' groups, consisting of 12 and 16 patients, respectively. We
identified three categories of prognostic factors: those related to patient,
disease, and treatment. We compared these prognostic factors between the
controlled and uncontrolled groups. RESULTS: In our study, the duration of
diabetes mellitus (DM), presence of inflammatory markers (C-reactive protein and
erythrocyte sedimentation rate), and computed tomography or magnetic resonance
imaging findings influenced the prognosis of MEO. In contrast, prognosis was
unrelated to age, gender, mean glucose level, hemoglobin A1c level, pathogen,
comorbidity, or cranial nerve involvement. No factor related to treatment
modality was correlated with prognosis, such as surgery, steroid therapy, or
interval to the first appropriate treatment. Cranial nerve involvement has been
proven to be associated with disease progression, but the relationship between
cranial nerve involvement and the prognosis of MEO remains controversial. As a
part of this study, we conducted a meta-analysis of cranial nerve involvement as
a prognostic factor of MEO. We found that cranial nerve involvement has a
statistically significant influence on the prognosis of MEO. CONCLUSION: We found
that glycemic control in diabetes mellitus, cranial nerve involvement, and the
extent of disease determined from various imaging modalities influence the
prognosis of MEO. We suggest that significant prognostic factors should be
monitored to determine the prognosis of patients with MEO.
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