Recommended
Recommended
More Related Content
Similar to Malignant Otitis Externa by Dr.S .pptx
Similar to Malignant Otitis Externa by Dr.S .pptx (20)
Recently uploaded
Recently uploaded (20)
Malignant Otitis Externa by Dr.S .pptx
- 1. MALIGNANT OTITIS EXTERNA (NECROTIZING OTITIS EXTERNA) BY DR. SRIHARIHARAN
- 2. OTITIS EXTERNA (OTO- EAR ITIS- INFLAMMATION) • Inflammation of the External auditory Canal • It can be acute or chronic, diffuse or localized • And can be caused by infection, allergy, irritation or Any Trauma
- 3. MALIGNANT OTITIS EXTERNA • It is an aggressive, inflammatory condition involving the outer ear canal progressively spreading to Involve skull base and the adjacent structures.
- 4. • Is it malignancy – NO • Misnomer • It is so called malignancy because of aggressive & life- threatening clinical progressive behavior, Poor treatment outcome (in later stages) & high mortality rate MALIGNANT OTITIS EXTERNA
- 6. PREDISPOSING FACTORS- MOE • Elderly People with uncontrolled Diabetes mellitus • Immunocompromised (HIV) Patients • Patients on chemotherapy/ Immunosuppressive drugs
- 7. • Most common organism- Pseudomonas aeruginosa a gram negative bacteria
- 8. SIGNS AND SYMPTOMS SYMPTOMS • Excruciating ear pain (noctural) • Purulent Discharge from the ear • Hearing loss • Fever • Headache
- 9. SIGNS & SYMPTOMS • Also Facial palsy (VII CN) • Dysphagia (IX & X CN) • Loss of voice (X CN) Facial Palsy
- 10. SIGNS • Tragal sign – Positive • Granulations present in auditory canal- Pathognomonic of MOE SIGNS AND SYMPTOMS
- 14. INVESTIGATIONS The initial investigation for OME is • CT scan – Reveals the bony destruction but is often not helpful
- 15. INVESTIGATIONS • Technetium 99 bone scan- reveals bone infection • But test remains positive for a year or so and cannot be used to monitor the disease.
- 16. INVESTIGATIONS • Gallium-67 is more useful in diagnosis and follow-up of the patient. • It is taken up by monocytes and reticuloendothelial cells, and is indicative of soft tissue infection. • It can be repeated every 3 weeks to monitor the disease and response to treatment.
- 17. INVESTIGATIONS Further Hematological investigations Helpful in further management and Treatment • Complete blood count • ESR ,CRP, Procalcitonin • FBS, PPBS, • HbAIC • Hearing test • Culture and sensitivity
- 18. GALLIUM 67
- 19. TREATMENT. • Toilet of ear canal Remove discharge, debris and granulations or any dead tissue or bone.
- 20. IV ANTIBIOTICS • Antibiotic treatment is continued for 6–8 weeks, sometimes more. • Third-generation cephalosporins e.g. ceftriaxone 1–2 g/day i.v. or ceftazidime 1–2 g/day i.v. are usually combined with an aminogly
- 21. ORAL ANTIBIOTICS • Quinolones (ciprofloxacin, ofloxacin and levofloxacin) are also effective and can be given orally. They can be combined with rifampin. • Ciprofloxacin 750 mg OD orally can be used.
- 22. HYPERBARIC OXYGEN THERAPY • HBO increases the partial pressure of oxygen improving hypoxia and allowing greater oxidative killing of bacteria. • Used only as an adjunct to antimicrobial therapy • Since the exact mechanism and success rate is very low, it is not widely used.
- 23. TREATMENT • Along with above course of treatment, The primary goal is to control Diabetes In Diabetic patients (or to treat the Primary cause) • Prolonged antibiotic treatment has replaced radical surgery and resections done earlier for this condition
- 24. FOLLOW UP Response to treatment • Earliest sign of response to therapy is decrease in nocturnal ear pain • Drop in ESR,CRP & procalcitonin • Gallium -67/ PET scan after treatment (usually after 6-8 weeks), useful in follow-up course of Treatment
- 25. PREVENTION • Avoid manipulation of the ear canal in immunocompromised patients • Don't use cotton buds to clean ears • Avoid aural irrigation • Early diagnosis and treatmentnecessary • Strict control of primary condition • Regular follow up
- 26. Thank you