1/53. osteomyelitis of the temporomandibular joint in patients with malignant otitis externa.Malignant (invasive) otitis externa is an infection involving the external ear canal, often in elderly diabetic patients, which carries a high morbidity and mortality. It may involve widespread areas of soft tissue around the skull base, and in more advanced cases, may give rise to osteomyelitis and cranial neuropathy. We describe two patients who were treated for malignant otitis externa complicated by destructive osteomyelitis of the temporomandibular joint (TMJ). For both patients, diagnosis was made using magnetic resonance imaging (MRI), and repeat scans were employed during follow-up. Improved scan appearances mirrored improvements in clinical condition in both cases.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
2/53. Necrotizing otitis externa caused by staphylococcus epidermidis.We present a case of malignant necrotizing otitis externa (MNOE) caused by staphylococcus epidermidis, which is usually a non-pathogenic microorganism. The patient is an otherwise healthy, nondiabetic 58-year-old white man. Contributory history began in 1994 after surgery for bilateral exostoses of the external auditory canals. Between April 1994 and May 1998 persistent otalgia occurred, with progressive mixed hearing losses, purulent discharge from both ears, spontaneous perforations of the tympanic membranes and ulceration of canal wall skin. From the beginning, Staph. epidermidis was isolated in all but one culture, but was not recognized as the pathological agent because of the presence of other more frequently involved bacteria and fungi. After multiple intravenous and oral antibiotics and antifungal treatments failed, further management involved frequent debridement of both external auditory canals and tympanic membranes, right tympanoplasty, bilateral mastoidectomy, revision tympanomastoidectomies and left modified radical mastoidectomy. Antistaphylococcal therapy including ceftazidime, vancomycin, teicoplanin, clindamycin and rifampicin was tried. Following the modified radical radical mastoidectomy, normalization of the status of his ears took approximately 2 months and has since remained stable to date. His left ear is deaf because of vancomycin administration, while magnetic resonance imaging and gallium scintigraphy have shown persistent inflammation of the skull base.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
3/53. When is a biopsy justified in a case of relapsing polychondritis?Relapsing polychondritis (RP) is a relatively rare rheumatic condition of unknown aetiology. It is characterized by recurrent episodic inflammation of cartilaginous structures (nose, ear and trachea). The clinical diagnosis of polychondritis can frequently be made with confidence in the absence of histological confirmation. A 61-year-old diabetic man, with bilateral relapsing aural inflammation, left ear deafness with tinnitus and pain at the sternocostal junctions is reported. After clinical diagnosis of relapsing polychondritis steroid therapy was started. An ear cartilage biopsy was performed confirming the clinical diagnosis. Subsequently soft tissue infection occurred at the operation site. The abscess was drained and oral ciprofloxacin was given with complete resolution of the infection over 30 days. As the infection is the main cause of death in these patients, we analyse whether biopsy is absolutely necessary for the diagnosis of RP in some patients.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
4/53. A case of malignant otitis externa following mastoidectomy.We present a case of a 63-year-old diabetic male who developed malignant otitis externa following mastoidectomy. Extensive skull base osteomyelitis caused thrombosis of the jugular bulb and subsequent paralysis of cranial nerves VII, IX, X and XII. He was treated aggressively with intravenous antibiotics and debridement of granulation tissue in the mastoid bowl with full recovery of the cranial nerve palsies associated with recanalization of the jugular bulb. We believe this is the first reported case of malignant otitis externa to occur following mastoidectomy with complete recovery of the cranial nerve paresis.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
5/53. Non-pseudomonal malignant otitis externa and jugular foramen syndrome secondary to cyclosporin-induced hypertrichosis in a diabetic renal transplant patient.We present the case of a 58-year-old diabetic renal transplant patient who developed a left jugular foramen syndrome, secondary to an ipsilateral staphylococcal malignant (necrotizing) otitis externa. This followed a protracted episode of uncomplicated otitis externa with no evidence of bone involvement on computed tomography (CT) scanning. Cyclosporin-induced hypertrichosis (excess hair growth) in his external auditory canal contributed greatly to the initial difficulty in managing his otitis externa. Following an initial successful treatment with prolonged intravenous antibiotics the patient relapsed with a secondary infection in the same anatomical site due to candida parapsilosis. Despite further intensive treatment including antimicrobials, a subtotal petrosectomy and hyperbaric oxygen therapy he eventually succumbed to his disease.- - - - - - - - - - ranking = 5keywords = diabetic (Clic here for more details about this article) |
6/53. Malignant otitis externa--a high index of suspicion is still needed for diagnosis.Malignant otitis externa is a destructive inflammatory process of the petrous temporal bone which if untreated leads to osteomyelitis of the skull base and can be fatal. It is more common in immunocompromised and elderly insulin-dependant diabetic patients and is caused by infection with Pseudomonas species. Despite a range of laboratory and radiological tests it still remains difficult to diagnose, particularly in the early stages when it can be treated medically. We describe three cases which presented to this department in the past twelve months. In all cases the diagnosis was made clinically and confirmed per-operatively. Interestingly all three cases were relatively young patients who did not have an immunocompromised status and were not diabetic.- - - - - - - - - - ranking = 2keywords = diabetic (Clic here for more details about this article) |
7/53. Malignant external otitis with multiple cranial nerve involvement.A case of bilateral malignment external otitis with multiple cranial nerve deficits is presented. Thirty-five similar cases reported in the world literature are reviewed. All cranial nerves have been involved with the exception of the first and fourth. The resultant pseudomonas ostemyelitis may be spread extensively in these elderly diabetic patients to involve the entire base of the skull as well as other structures. The preferred treatment is long term systemic antibiotics followed by surgical intervention for plateau or further progression of disease. The overall mortality is 61 percent (22/36), a lower figure than previously reported.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
8/53. Human immunodeficiency virus and invasive external otitis--a case report.Acute invasive external otitis is an uncommon life-threatening infection of the external auditory canal (EAC), most often affecting the elderly diabetic patients. Although few reports have been made in hiv-positive/Aids patients among the caucasians. We present here a 25 year old nursing mother with a month history of fever, persistent otalgia with acutely inflammed EAC, gross facial cellulitis, mastoid abscess and facial paresis, following a minor left ear trauma with a matchstick. This unusual course of ear infection in an otherwise healthy young adult prompts a search for an immunodepressing factor which was confirmed to be Human Immunodeficiency Virus (hiv). This article highlights the clinical peculiarities and the management of invasive external otitis in an hiv-positive patient.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
9/53. Malignant otitis externa due to aspergillus niger.The case is reported of a 73-y-old diabetic man with malignant otitis externa due to aspergillus niger. Cure was achieved with a 3 week course of intravenous amphotericin b, followed by oral itraconazole for 3 months. The characteristics and the outcome of 13 reported cases of malignant otitis externa caused by Aspergillus sp. are presented.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
10/53. Central skull base osteomyelitis in patients without otitis externa: imaging findings.BACKGROUND AND PURPOSE: skull base osteomyelitis typically arises as a complication of ear infection in older diabetic patients, involves the temporal bone, and has pseudomonas aeruginosa as the usual pathogen. Atypical skull base osteomyelitis arising from the sphenoid or occipital bones without associated external otitis occurs much less frequently and initially may have headache as the only symptom. The purpose of this study was to review the clinical and MR imaging features of central skull base osteomyelitis. methods: We retrospectively reviewed MR images obtained in six patients with central skull base osteomyelitis. No patient had predisposing external otitis or osteomyelitis of the temporal bone. RESULTS: All of our patients presented with headache, no external ear pain, and cranial nerve deficits. Five of six patients had a predisposition to infection, and the erythrocyte sedimentation rate was elevated in the five patients in whom it was checked. In each case, the diagnosis was delayed until MR imaging demonstrated central skull base abnormality, and the diagnosis was then confirmed with tissue sampling. The most consistent imaging findings were clival bone marrow T1 hypointensity and preclival soft tissue infiltration. Five of six patients were cured with no recurrence of skull base infection over a 2-4-year follow-up period. CONCLUSION: In the setting of headache, cranial neuropathy, elevated erythrocyte sedimentation rate, and abnormal clival imaging findings, central skull base osteomyelitis should be considered as the likely diagnosis. Early tissue sampling and appropriate treatment may prevent or limit further complications such as intracranial extension, empyema, or death.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
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