title: Malignant external otitis: analysis of severe cases.
abstract: OBJECTIVE
  To study the effect of specific clinical, laboratory, and imaging parameters on the course of severe (type 1) malignant external otitis (MEO).
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary, university-affiliated medical center.
  
  
  METHODS
  Fifty-seven patients hospitalized with severe MEO were followed for disease course and survival in a tertiary center between 1990 and 2008.
  
  
  RESULTS
  In 20% of patients, disease was persistent and/or aggressive despite prolonged and extensive treatment. Of this subgroup, 45% died of the disease. Prognostic factors of persistent/aggressive disease were facial nerve paralysis, bilateral disease, and significant major computed tomography findings (temporomandibular joint destruction, infratemporal fossa or nasopharyngeal soft tissue involvement). Cultures grew fungi in 5 patients, and follow-up imaging revealed disease progression. The overall 5-year survival was 55% for patients with short-term disease and 40% for patients with persistent/ aggressive disease (P = .086). By age, 5-year survival was 75% in patients younger than 70 years old and 44% in older patients (P = .029).
  
  
  CONCLUSIONS
  A significant subset of patients with MEO has a prolonged, aggressive, and highly fatal disease that needs to be identified early. These patients more frequently have bilateral disease, cranial nerve paralysis, and positive computed tomography findings. Their follow-up should routinely include imaging studies to evaluate disease progression, and every effort should be made to identify and treat underlying fungal infection.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tiqwa, Israel.
authors.forename: Ethan
authors.initials: E
authors.lastname: Soudry
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Hamzany
authors.forename: Michal
authors.initials: M
authors.lastname: Preis
authors.forename: Benzion
authors.initials: B
authors.lastname: Joshua
authors.forename: Tuvia
authors.initials: T
authors.lastname: Hadar
authors.forename: Ben I
authors.initials: BI
authors.lastname: Nageris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010032:Otitis Externa / Q000145:classification / Q000175:diagnosis* / Q000401:mortality; D012720:Severity of Illness Index; D015996:Survival Rate