title: Necrotizing otitis externa: 19 cases' report.
abstract: Necrotizing otitis externa is an uncommon but severe infectious disease of the external auditory canal. Patients at risk are those immunodepressed or having diabetes. The causal germ is often Pseudomonas aeruginosa. Over a period of 10 years (1997-2006), we treated 19 patients: 94.7% had diabetes (insulin dependent in 6 cases). The causal germ was P. aeruginosa in 59% of cases. The pretherapeutic work-up included a computed tomography and a scintigraphy practiced in order to confirm diagnosis and assess the extension. Medical treatment was based on a parenteral antibiotic therapy using a third-generation cephalosporin and a fluoroquinolones. Local treatment of the auditory canal including cleaning and application of antimicrobial agents was performed in all the cases. Surgical debridement of soft tissue and infected bone was performed in one patient who did not respond to medical management. Repeated scintigraphies with gallium were used to follow the course under treatment in only three cases. We had a 89.4% cure rate with only three cases of recurrence. We reviewed the data in the literature on necrotizing otitis externa and present the important diagnostic, imaging, and therapeutic aspects of the disease.
authors.affiliation: ENT Department, Habib Thameur Hospital, Tunis, Tunisia.
authors.forename: Ines
authors.initials: I
authors.lastname: Hariga
authors.forename: Ali
authors.initials: A
authors.lastname: Mardassi
authors.forename: Faten
authors.initials: F
authors.lastname: Belhaj Younes
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ben Amor
authors.forename: Sarra
authors.initials: S
authors.lastname: Zribi
authors.forename: Olfa
authors.initials: O
authors.lastname: Ben Gamra
authors.forename: Chiraz
authors.initials: C
authors.lastname: Mbarek
authors.forename: Abdelkader
authors.initials: A
authors.lastname: El Khedim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement; D013293:Enterococcus faecalis; D005260:Female; D005500:Follow-Up Studies; D006314:Hearing Loss, Conductive / Q000175:diagnosis / Q000209:etiology; D046089:Hearing Loss, Mixed Conductive-Sensorineural / Q000175:diagnosis / Q000209:etiology; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009894:Opportunistic Infections / Q000628:therapy; D010032:Otitis Externa / Q000175:diagnosis* / Q000628:therapy; D011512:Proteus Infections / Q000175:diagnosis* / Q000628:therapy; D011552:Pseudomonas Infections / Q000175:diagnosis* / Q000628:therapy; D011550:Pseudomonas aeruginosa; D011551:Pseudomonas fluorescens; D011877:Radionuclide Imaging; D012008:Recurrence; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014416:Tunisia
chemical_list: D000900:Anti-Bacterial Agents