“NECROTISING OTITIS EXTERNA: AN OVERVIEW OF IMAGING MODALITIES“
AbstractNecrotising Otitis Externa (NOE) has often posed some challenges in view of diagnosis and management by clinicians. One such challenge is the appropriate and timely use of imaging techniques, since its use is critical not only in diagnosis but also determining the extent and resolution of the disease. Hence, doctors in both primary and secondary health care need to be familiar with presenting symptoms, while specialists need to be appraised of advances in imagining techniques in management of NOE. Whilst there is a general consensus amongst clinicians on some aspects of management of NOE, there is very limited consensus on the use of imaging modalities. There is no single modality of imaging that can provide a complete picture of diagnosis, disease progression and resolution. There are some advantages and limitation of each methodology, which indicate that a multi-modal imaging technique at particular stages of the disease may provide better management outcomes. However, further research in this area is required, as there is not yet an established ‘gold standard’ for imaging in NOE. Keywords: Necrotising Otitis Externa; Malignant Otitis Externa; Skull base Osteomyelitis; Tc-99m bone scan; Ga-67 bone scan; Indium 111 labelled leukocyte scanning; SPECT
van Kroonenburgh AMJL, van der Meer WL, Bothof RJP, van Tilburg M, van Tongeren J, Postma AA. Advanced Imaging Techniques in Skull Base Osteomyelitis Due to Malignant Otitis Externa. Curr Radiol Rep 2018;6(1):3.
Adams A, Offiah C. Central skull base osteomyelitis as a complication of necrotizing otitis externa: Imaging findings, complications, and challenges of diagnosis. Clin Radiol 2012;67(10):e7–16.
Okpala NC, Siraj QH, Nilssen E, Pringle M. Radiological and radionuclide investigation of malignant otitis externa. J Laryngol Otol 2005;119(1):71–5.
Singh J, Bhardwaj B. The Role of Surgical Debridement in Cases of Refractory Malignant Otitis Externa. Indian J Otolaryngol Head Neck Surg 2018;70(4):549–54.
Rubin J, Yu VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis, and therapy. Am J Med 1988;85(3):391–8.
Handzel O, Halperin D. Necrotizing (malignant) external otitis. Am Fam Physician 2003;68(2):309–12.
Bhandary S, Karki P, Sinha BK. Malignant otitis externa: a review. Pac Health Dialog 2002;9(1):64–7.
Bhat V, Aziz A, Bhandary SK, Aroor R, Kamath P SD, Saldanha M. Malignant Otitis Externa - A Retrospective Study of 15 Patients Treated in a Tertiary Healthcare Center. J Int Adv Otol 2015;11(1):72–6.
Bernstein J. Malignant Otitis Externa. J ENT Mastercl 2009;2(1):137–42.
Health Conditions & Treatments - Diabetes, Cancer, Symptom Checker [Internet]. AARP. [cited 2020 Dec 20]. Available from: https://www.aarp.org/health/conditions-treatments/
Carfrae MJ, Kesser BW. Malignant otitis externa. Otolaryngol Clin North Am 2008;41(3):537–49.
Shamanna K, Ganga VB. Changing trends in the management of malignant otitis externa: our experience. Res Otolaryngol 2018;7(1):9–14.
Rubin Grandis J, Branstetter BF, Yu VL. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis 2004;4(1):34–9.
Grandis JR, Curtin HD, Yu VL. Necrotizing (malignant) external otitis: prospective comparison of CT and MR imaging in diagnosis and follow-up. Radiology 1995;196(2):499–504.
Di Lullo AM, Russo C, Piroli P, Petti A, Capriglione P, Cantone E, et al. Malignant Otitis External: Our Experience and Literature Review. Am J Case Rep 2020;21:e925060.
Franco-Vidal V, Blanchet H, Bebear C, Dutronc H, Darrouzet V. Necrotizing external otitis: a report of 46 cases. Otol Neurotol 2007;28(6):771–3.
Adegbiji WA, Olajide GT. Pattern of otalgia in Ekiti, Nigeria. Am J Med Sci Med 2017;5(3):56–61
Cooper T, Hildrew D, McAfee JS, McCall AA, Branstetter BF, Hirsch BE. Imaging in the Diagnosis and Management of Necrotizing Otitis Externa: A Survey of Practice Patterns. Otol Neurotol 2018;39(5):597–601.
Curtin HD, Wolfe P, May M. Malignant external otitis: CT evaluation. Radiology 1982;145(2):383–8.
Trojanowska A, Drop A, Trojanowski P, Rosińska-Bogusiewicz K, Klatka J, Bobek-Billewicz B. External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms. Insights Imaging 2012;3(1):33–48.
Cherko M, Nash R, Singh A, Lingam RK. Diffusion-weighted Magnetic Resonance Imaging as a Novel Imaging Modality in Assessing Treatment Response in Necrotizing Otitis Externa. Otol Neurotol 2016;37(6):704–7.
Stokkel MP, Takes RP, van Eck-Smit BL, Baatenburg de Jong RJ. The value of quantitative gallium-67 single-photon emission tomography in the clinical management of malignant external otitis. Eur J Nucl Med 1997;24(11):1429–32.
Al Aaraj MS, Kelley C. Malignant Otitis Externa. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. [cited 2020 Dec]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556138/
Redleaf MI, Angeli SI, McCabe BF. Indium 111-labeled white blood cell scintigraphy as an unreliable indicator of malignant external otitis resolution. Ann Otol Rhinol Laryngol 1994;103(6):444–8.