Malignant otitis externa, an increasing burden in the twenty-first century: review of cases in a UK teaching hospital, with a proposed algorithm for diagnosis and management
Malignant otitis externa, an increasing burden in the twenty-first century: review of cases in a UK teaching hospital, with a proposed algorithm for diagnosis and management
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DOI：
10.1017/s0022215119000604
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发表时间：
2019-05-01
影响因子：
1.7
通讯作者：
Watson, G. J.
中科院分区：
文献类型：
--
作者：
Hutson, K. H.;Watson, G. J.
背景恶性外耳炎是一种潜在的致命性颅底感染。随着人口老龄化和糖尿病患病率的增加，英国人口中恶性外耳炎的发病率正在上升。到目前为止，仍然没有公认的诊断标准，几乎没有预后指标，也没有达成共识的治疗途径。方法在某三级转诊教学医院进行前瞻性病例系列研究。结果易感人群(老年人、男性、免疫抑制和糖尿病)占主导地位，25%的人报告有既往事件。耳鸣、耳痛和管内肉芽肿是最常见的表现特征，此外还有假单胞菌培养阳性。没有明确的标记物来预测疾病的严重程度；然而，较高的初始血红蛋白A1c水平与治疗时间呈显著的中度正相关。结论提出了一种标准化的检查和治疗方法，旨在提高早期诊断、简化护理和促进最佳实践的发展。
Background Malignant otitis externa is a potentially fatal infection of the skull base. With an ageing population and increasing prevalence of diabetes, the incidence of malignant otitis externa in the British population is rising. To date, there remain no accepted diagnostic criteria, few prognostic indicators and no consensus treatment pathways. Method A prospective case series was conducted at a tertiary referral teaching hospital. Results A cohort of susceptible individuals predominates (elderly, male, with immunosuppression and diabetes), with 25 per cent reporting a preceding incident. Otorrhoea, otalgia and canal granulation were the commonest presenting features, alongside positive pseudomonas cultures. No clear markers for predicating disease severity were isolated; however, a high initial haemoglobin A1c level demonstrated a significant moderately positive correlation with length of treatment. Conclusion A treatment pathway designed to provide a standardised approach to investigation and treatment is proposed, which aims to increase earlier diagnosis, streamline care and facilitate the development of best practice.