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

W Leentje van der Meer; Ahmed B Bayoumy; Josje J Otten; Jerome J Waterval; Henricus P M Kunst; Alida A Postma

doi:10.1016/j.joto.2022.05.002

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

W Leentje van der Meer, Ahmed B Bayoumy^*, Josje J Otten, Jerome J Waterval, Henricus P M Kunst, Alida A Postma

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objectives: 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.Methods: Retrospective chart review from 2010 to 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.Results: 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.Conclusion: 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 of evidence: Level IV.(c) 2022 PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Original language	English
Pages (from-to)	156-163
Number of pages	8
Journal	Journal of Otology
Volume	17
Issue number	3
DOIs	https://doi.org/10.1016/j.joto.2022.05.002
Publication status	Published - Jul 2022

Keywords

Necrotizing external otitis
Malignant external otitis
Skull base osteomyelitis
Clinical manifestation
Spreading routes
Antibiotic exposure
Facial nerve palsy
PIPERACILLIN-TAZOBACTAM
INVOLVEMENT
DIAGNOSIS

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Cite this

@article{4698d951c47647a39864b37aba71703a,

title = "The association between radiological spreading pattern and clinical outcomes in necrotizing external otitis",

abstract = "Objectives: 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.Methods: Retrospective chart review from 2010 to 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.Results: 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.Conclusion: 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 of evidence: Level IV.(c) 2022 PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).",

keywords = "Necrotizing external otitis, Malignant external otitis, Skull base osteomyelitis, Clinical manifestation, Spreading routes, Antibiotic exposure, Facial nerve palsy, PIPERACILLIN-TAZOBACTAM, INVOLVEMENT, DIAGNOSIS",

author = "{van der Meer}, {W Leentje} and Bayoumy, {Ahmed B} and Otten, {Josje J} and Waterval, {Jerome J} and Kunst, {Henricus P M} and Postma, {Alida A}",

note = "Funding Information: There was no funding received for this work from any of the following organizations: National Institutes of Health (NIH), Wellcome Trust, Howard Hughes Medical Institute (HHMI), and others. Publisher Copyright: {\textcopyright} 2022 PLA General Hospital Department of Otolaryngology Head and Neck Surgery",

year = "2022",

month = jul,

doi = "10.1016/j.joto.2022.05.002",

language = "English",

volume = "17",

pages = "156--163",

journal = "Journal of Otology",

issn = "1672-2930",

publisher = "Elsevier (Singapore) Pte Ltd",

number = "3",

}

TY - JOUR

T1 - The association between radiological spreading pattern and clinical outcomes in necrotizing external otitis

AU - van der Meer, W Leentje

AU - Bayoumy, Ahmed B

AU - Otten, Josje J

AU - Waterval, Jerome J

AU - Kunst, Henricus P M

AU - Postma, Alida A

N1 - Funding Information: There was no funding received for this work from any of the following organizations: National Institutes of Health (NIH), Wellcome Trust, Howard Hughes Medical Institute (HHMI), and others. Publisher Copyright: © 2022 PLA General Hospital Department of Otolaryngology Head and Neck Surgery

PY - 2022/7

Y1 - 2022/7

N2 - Objectives: 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.Methods: Retrospective chart review from 2010 to 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.Results: 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.Conclusion: 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 of evidence: Level IV.(c) 2022 PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

AB - Objectives: 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.Methods: Retrospective chart review from 2010 to 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.Results: 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.Conclusion: 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 of evidence: Level IV.(c) 2022 PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

KW - Necrotizing external otitis

KW - Malignant external otitis

KW - Skull base osteomyelitis

KW - Clinical manifestation

KW - Spreading routes

KW - Antibiotic exposure

KW - Facial nerve palsy

KW - PIPERACILLIN-TAZOBACTAM

KW - INVOLVEMENT

KW - DIAGNOSIS

U2 - 10.1016/j.joto.2022.05.002

DO - 10.1016/j.joto.2022.05.002

M3 - Article

C2 - 35847573

SN - 1672-2930

VL - 17

SP - 156

EP - 163

JO - Journal of Otology

JF - Journal of Otology

IS - 3

ER -