Malignant External Otitis: Analysis of Severe Cases
Malignant External Otitis: Analysis of Severe Cases
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DOI：
10.1177/0194599810396132
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发表时间：
2011-05-01
影响因子：
3.4
通讯作者：
Nageris, Ben I.
中科院分区：
文献类型：
--
作者：
Soudry, Ethan;Hamzany, Yaniv;Nageris, Ben I.
目标。目的：探讨临床、实验室及影像学指标对重度（1型）恶性外耳炎（MEO）病程的影响。研究设计。案例系列与图表回顾。设置。大专、大学附属医疗中心。研究对象和方法。本研究于1990年至2008年对57例重度MEO住院患者的病程和生存情况进行了随访。在20%的患者中，尽管进行了长期和广泛的治疗，但疾病仍持续存在和/或具有侵袭性。在这个亚组中，45%的人死于这种疾病。持续性/侵袭性疾病的预后因素是面神经麻痹、双侧疾病和显著的主要计算机断层扫描结果（颞下颌关节破坏、颞下窝或鼻咽软组织受累）。5例患者培养出真菌，随访影像显示疾病进展。短期疾病患者的总体5年生存率为55%，持续性/侵袭性疾病患者的总体5年生存率为40% （P = 0.086）。按年龄划分，70岁以下患者的5年生存率为75%，老年患者的5年生存率为44% （P = 0.029）。相当一部分MEO患者病程持续时间长、侵袭性强且高度致命，需要及早发现。这些患者更常有双侧疾病、脑神经麻痹和阳性的计算机断层扫描结果。他们的随访应常规包括影像学检查以评估疾病进展，并应尽一切努力识别和治疗潜在的真菌感染。
Objective. To study the effect of specific clinical, laboratory, and imaging parameters on the course of severe (type 1) malignant external otitis (MEO).Study Design. Case series with chart review.Setting. Tertiary, university-affiliated medical center.Subjects and 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.