title: Malignant Otitis Externa: A Novel Stratification Protocol for Predicting Treatment Outcomes.
abstract: OBJECTIVE
  1) Stratify malignant otitis externa into severe and nonsevere disease categories. 2) Predict treatment courses and outcomes based on this stratification.
  
  
  METHODS
  Tertiary center.
  
  
  METHODS
  Retrospective review 2004 to 2014; 28 patients. Inclusion criteria are a diagnosis by senior authors, radiographic evidence of disease, admission for intravenous antibiotics/debridement, minimum 1 year of follow-up.
  
  
  METHODS
  Severe group stratification if two or more of the following: cranial nerve VII palsy, fungal positive culture, relapse, surgery performed, major radiographic findings. All other patients stratified to nonsevere group.
  
  
  METHODS
  Cure, alive/refractory disease, death by disease, death by other cause. Secondary measures are antibiotic duration and number of disease-related admissions.
  
  
  RESULTS
  Forty-three percent (12 of 28) and 57% (16 of 28) of patients stratified into the severe and nonsevere groups. The severe group had significantly more adverse disease-specific outcomes than the nonsevere group (7 of 12 versus 0 of 16; p = 0.002). Disease-specific mortality was 42% and 0% in the severe and nonsevere groups, respectively. The severe group had longer antibiotic courses (12.8 versus 6.9 wk; p = 0.01) and more disease-related admissions/relapses (1.6 versus 1, p < 0.001). Only four of 12 severe group patients achieved cure. All but two nonsevere patients achieved cure, with those two dying of other causes.
  
  
  CONCLUSIONS
  A subgroup of malignant otitis externa may exist that is not as susceptible to parenteral antibiotics and local debridement. A combination of clinical and radiographic findings may be useful for stratifying patients into severe/nonsevere categories. Patients with severe disease may be more likely to die of their disease and have worse treatment courses such that additional surgical intervention may be indicated.
authors.affiliation: *Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina †Ralph H. Johnson, Veterans Affairs Medical Center, Charleston, South Carolina, U.S.A.
authors.forename: Shawn M
authors.initials: SM
authors.lastname: Stevens
authors.forename: Paul R
authors.initials: PR
authors.lastname: Lambert
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Baker
authors.forename: Ted A
authors.initials: TA
authors.lastname: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000145:classification* / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D002908:Chronic Disease; D003646:Debridement; D048909:Diabetes Complications / Q000145:classification* / Q000000981:diagnostic imaging / Q000628:therapy; D003920:Diabetes Mellitus; D018450:Disease Progression; D004927:Escherichia coli Infections / Q000145:classification* / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D005155:Facial Nerve Diseases / Q000209:etiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D010019:Osteomyelitis / Q000145:classification* / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D010032:Otitis Externa / Q000145:classification* / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D011552:Pseudomonas Infections / Q000145:classification* / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000145:classification* / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents