Malignant External Otitis

(Osteomyelitis of the skull base; necrotizing otitis externa)

The malignant external otitis, which is also called Schädelbasisosteomyelitis or necrotizing otitis externa is usually temporal Pseudomonas osteomyelitis of the os. Methicillin-resistant Staphylococcus aureus (MRSA) has been reported as a cause.

From infection connective tissue, cartilage and bone are affected. The osteomyelitis spreads out along the base of the skull and can lead to cranial neuropathies (VIIist usually affected first, followed by IX, X and XI) and can cross the center line.

The malignant external otitis, which is also called Schädelbasisosteomyelitis or necrotizing otitis externa is usually temporal Pseudomonas osteomyelitis of the os. Methicillin-resistant Staphylococcus aureus (MRSA) has been reported as a cause. From infection connective tissue, cartilage and bone are affected. The osteomyelitis spreads out along the base of the skull and can lead to cranial neuropathies (VIIist usually affected first, followed by IX, X and XI) and can cross the center line. At a malignant external otitis mainly older patients with diabetes or immune deficiencies ill. They often begins as Pseudomonas infection in the outer ear. Methicillin-resistant Staphylococcus aureus (MRSA) has been identified as the cause. Typical symptoms include continued strong, low-set ears pain (often worse at night), foul-smelling pus from the ear and granulation tissue or exposed bone in the ear canal (usually at the transition between the bony and cartilaginous section). There may be a conductive hearing loss of variable severity. In severe cases, a paralysis of the facial nerve, and even the lower cranial nerves (IX, X or XI) develop, if the erosive and potentially life-threatening infection along the base of the skull (osteomyelitis of the skull base) from the stylomastoid foramen until the jugular foramen and above spreading out. Diagnostic CT scan of the temporal bone, the diagnosis is based on high-resolution CT display of the temporal bone that can show in the middle ear increased radiation density of the air cells in the mastoid and some radiolucent (demineralized) areas. The identification of a bony erosion confirmed the diagnosis. To distinguish this disorder from a malignant tumor tissue biopsies are taken from the ear canal and created cultures. Therapy Systemic antibiotics, typically a fluoroquinolone and / or a combination of aminoglycoside and a semi-synthetic penicillin topical antibiotic / steroid preparations (eg. As ciprofloxacin / dexamethasone) Rare surgical debridement The treatment is generally carried out with a 6-week i. v. Passing a culture directed fluoroquinolone (z. B. ciprofloxacin, 400 mg i. .v every 8 h) and / or a semi-synthetic penicillin (piperacillin-tazobactam or piperacillin) / aminoglycoside combination (for ciprofloxacin resistant Pseudomonas). Lighter cases with close follow-up can, however, also on an outpatient basis with a high-dose oral fluoroquinolone (z. B. ciprofloxacin, 750 mg p.o. every 12 h) to be treated. The treatment includes topical ciprofloxacin / dexamethasone preparations (z. B. ear drops, impregnated dressings channel). Hyperbaric oxygen can be a useful adjunctive treatment, where his final role is not yet clear. the consulting a specialist in infectious diseases, to determine the optimal duration of antibiotic therapy, and an endocrinologist to strictly adjust the blood glucose is recommended. Prolonged bone disease antibiotic therapy must be continued even longer possibly. Importantly, careful control of your diabetes. Frequent “office debridement” is necessary to remove granulation tissue and purulent discharge. Surgery is usually not necessary, but surgical debridement can be used in broader infections.

Health Life Media Team

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