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Ga 67 scan: Long-term follow-up with Ga 67 (Gallium Citrate) scan highlights the marked accumulation in the temporal region and extends to the skull base (indicated by the arrows).
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Purpose
The progression of the otitic infectious process toward diseases of particular severity is often unpredictable, just as it is challenging to manage the patient over time, even after the apparent resolution of the disease. We aim to define a radiological reading key that allows us to correctly and promptly treat the disease, avoiding the pos...
Citations
... The symptoms of skull base osteomyelitis vary and may initially present as seemingly benign, such as headaches, which can progress to cranial nerve palsies as the disease progresses. Severe otalgia is disproportionate to clinical signs of external ear infection and is a common complaint among patients [18]. ...
Introduction: Skull Base Osteomyelitis (SBO) is an infectious inflammation of the skull bones that is often caused by malignant otitis externa (MOE) and affects the temporal bone. This condition commonly affects immunocom-promised individuals and the elderly, particularly those with a history of diabetes mellitus. Diagnosis is challenging because of non-specific symptoms that lead to late detection and complications. This report discusses a case of SBO with multiple bilateral cranial nerve abnormalities and highlights the diagnostic and management challenges in high-risk individuals with subtle clinical signs. Case presentation: This report describes a 63-year-old patient with hypertension and diabetes who underwent surgical debridement of the left ear due to malignant otitis externa 4 months prior to presentation. The patient presented with significant dysarthria, dysphagia, ptosis of the left eye with double vision, and hearing impairment in the left ear. Examination revealed bilateral CN VI palsy, right CN VII palsy, left CN VIII palsy, and a right CN XII deficit. Initial tests were unremarkable, but a high Fungitell assay and a second review of the CT scan and MRI revealed a pathological process in the base of the skull involving bony structures and cranial nerves bilaterally , which helped diagnose SBO. The patient was subsequently discharged with oral voriconazole and continued his usual medications. The patient requested further management abroad, because he did not notice resolution of his symptoms. Surgical treatment was employed abroad to relieve his symptoms, as he recovered slowly. Conclusion: This case report underscores the importance of a multidisciplinary approach to address SBO. Collaboration between specialists in infectious diseases, otolaryngology, radiology, and neurology plays a pivotal role in achieving an accurate diagnosis and developing a tai-How to cite this paper: Kuuzie,
... More importantly, most healthcare services considered not urgent or elective (such as the SLP clinics) have experienced a considerable interruption or fragmentation of their activities [18]. Therefore, the COVID-19 pandemic has obliged the healthcare system to significantly transform its service offer and delivery modality, thus promoting a rapid expansion of the telehealth and TRH [19][20][21]. ...
We report on our remote speech therapy experience in post-stroke aphasia. The
aim was to test the feasibility and utility of telerehabilitation to support
future randomized controlled trials. Post-stroke aphasia is a common and
disabling speech disorder, which significantly affects patients’ and caregivers’
health and quality of life. Due to COVID-19 pandemic, most of the conventional
speech therapy approaches had to stop or “switch” into telerehabilitation
procedures to ensure the safety of patients and operators but, concomitantly, the
best rehabilitation level possible. Here, we planned a 5-month telespeech therapy
programme, twice per week, of a patient with non-fluent aphasia following an
intracerebral haemorrhage. Overall, treatment adherence based on the operator’s
assessments was high, and incomplete adherence for technical problems occurred
very rarely. In line with the patient’s feedback, acceptability was also
positive, since he was constantly motivated during the sessions and the exercises
performed autonomously, as confirmed by the speech therapist and caregiver,
respectively. Moreover, despite the sequelae from the cerebrovascular event,
evident in some writing tests due to the motor deficits in his right arm and the
disadvantages typical of all telepractices, more relevant results were achieved
during the telerehabilitation period compared to those of the “face-to-face”
therapy before the COVID-19 outbreak. The telespeech therapy performed can be
considered successful and the patient was able to return to work. Concluding, we
support it as a feasible approach offering patients and their families the
opportunity to continue the speech and language rehabilitation pathway, even at
the time of pandemic.
... Several ear disorders correlated in literature with anaerobic bacteria infection, influencing the prognosis of serious diseases such as lateral cervical and mediastinal involvements; however excellent response to hyperbaric therapy combined with antibiotics and cortisone drugs has been reported [17,18]. ...
Background:
Acute acoustic trauma (AAT) ranks, among others, as one common cause of inner ear function impairment, especially in terms of military personnel, who are at an increased exposure to impulse noises from firearms.
Aim of this study:
1. We wanted to demonstrate whether early treatment of AAT means a higher chance for the patient to improve hearing after trauma. 2. We find the answer to the question of whether hyperbaric oxygen therapy (HBO2) has a positive effect in the treatment of AAT.
Methods:
We retrospectively analyzed data for the period 2004-2019 in patients with AAT. We evaluated the therapeutic success of corticosteroids and HBO2 in a cohort of patients with AAT n = 108 patients/n = 141 affected ears.
Results:
Hearing improvement after treatment was recorded in a total of 111 ears (79%). In terms of the data analysis we were able to ascertain, utilizing success of treatment versus timing: within 24 h following the onset of therapy in 56 (40%) ears-54 (96%) ears had improved; within seven days following the onset the therapy was used in 55 (39%) ears-41 (74%) ears had improved; after seven days the therapy started in 30 (21%) ears-16 (53%) ears had improved. Parameter latency of the beginning of the treatment of AAT was statistically significant (p = 0.001 and 0.017, respectively). The success of the medical protocols was apparent in both groups-group I (treated without HBO2): n = 61 ears, of which 50 (82%) improved, group II (treated with HBO2): n = 73 ears, of which 56 (77%) improved. Group II shows improvement at most frequencies (500-2000 Hz). The most serious sensorineural hearing loss after AAT was at a frequency of 6000 Hz.
Conclusion:
Analysis of our data shows that there is a statistically significant higher rate of improvement if AAT treatment was initiated within the first seven days after acoustic trauma. Early treatment of AAT leads to better treatment success. HBO2 is considered a rescue therapy for the treatment of AAT. According to our recommendation, it is desirable to start corticosteroid therapy immediately after acoustic trauma. If hearing does not improve during the first seven days of corticosteroid therapy, then HBO2 treatment should be initiated.
... Oral lesions's diagnosis could be very difficult both in adults than children (16)(17)(18)(19) . Differential diagnosis should consider several different disorders, from infection-induced lesions to neoplasms (20)(21)(22) . ...
... However, a large case-control study reported no significant associations between GERD and dental erosion or tooth sensitivity, but significant associations between GERD and xerostomia, oral acid / burning sensation, subjective halitosis, and erythema of the palatal mucosa and uvula (27) . Additionally, a randomized clinical trial showed quantitatively short-term suppression of active dental erosion following treatment of medically confirmed GERD with a proton pump inhibitor (PPI) (17) . Intraesophageal refluxes contain a mixed composition of gas and liquid associated with GERD symptoms could led to endogenous tooth erosion (28,29) . ...
Introduction: The aim of the study is to evaluate the correlation between the presence of pepsin in saliva and dental erosion in patients with GERD. Materials and methods: 100 adult patients with typical GERD symptoms have been tested with the salivary pepsin test (PEPTEST which was used to assess the presence of pepsin in saliva and, therefore, for the diagnosis of GERD. The presence and the localization of dental erosion was evaluated through a dental examination. Results: In 52% of the patients the PEP test was positive. It was shown that out of 52 patients with gastroesophageal reflux disease, 16 (30%) had dental erosions, while in the remaining 48 healthy subjects only 4 patients (8%) showed dental erosions. Conclusions: The results showed a positive correlation between the presence of pepsin and dental erosion. A multidisciplinary approach between the gastroenterologist and the dentist is very important in order to plan and implement the most suitable therapeutic strategy that aims to restore a state of health of all the anatomical districts concerned.
Malignant otitis externa is an infection of the skin and soft tissue of the ear canal, spreading to the nearby structures. It causes severe otalgia and otorrhea, and can lead to ominous consequences such as cranial nerve damage and meningitis. The main etiologic agent is Pseudomonas aeruginosa and treatment relies on broad-spectrum intravenous antibiotics. We report a rare case of a woman suffering from Malignant otitis externa caused by Acinetobacter baumannii and requiring the use of colistin.
Otalgia is an ear pain and is common affecting people of all ages with almost a 100% lifetime prevalence [1, 2]. Otalgia can be broken down into two categories of primary (otogenic) otalgia and secondary otalgia regarding its causes. Primary otalgia arises as a consequence of otologic diseases, and secondary otalgia arises from pathologic processes in structures other than the ear. Otalgia can be referred to as a primary otalgia when the etiology of otalgia is limited within the affected ear and the cause of otalgia can be identified by otoendoscopic examination. Primary otalgia can be caused by otitis externa, acute or chronic otitis media, impacted cerumen, mastoiditis, folliculitis, myringitis, and neoplasm [3]. Primary otalgia is far more common in children than in adults, and secondary otalgia is more common in adults [1–3]. When the pathoetiology of otalgia cannot be identified through physical examination and otoendoscopy, the cause of secondary otalgia should be investigated. Sensory innervation of the ear is provided by a complex neural network as a result of complex embryogenic development. Because the ear shares this complex neural network with other organs, numerous sources of secondary otalgia can be possible. Cranial nerves (CNs) V (trigeminal), VII (facial), IX (glossopharyngeal), X (vagus), and branches from the cervical plexus (C1, C2, and C3) all innervate the middle ear, external auditory canal, auricle and peri-auricular tissues, and irritation of any portion of CNs V, VII, IX, X or C1, 2, and 3 may cause otalgia. The auricle is innervated by CNs V, VII, X, C2, and C3, the external auditory canal is innervated by CNs V, VII, and X, the tympanic membrane is innervated by CNs VII, IX, and X, and the middle ear is innervated by CNs V, VII, and IX. The location of nerve irritation can be remote from the ear, and, for example, otalgia may be the sole manifestation of myocardial ischemia because the CN X innervates both the ear and heart [4–6]. Furthermore, although most secondary otalgia is caused by the problems of the neck, cervical spine, and temporomandibular joints, more ominous causes of otalgia such as occult malignancy should be taken into consideration.
The book of the special issue: The impact of ENT disease in social life
External auditory canal Carcinomas are rare and aggressive tumors and their prognosis depends on early diagnosis. Their clinical similarity to necrotizing otitis is a source of error and therefore of diagnostic delay. Hence the interest of our study which consists in providing ENT specialists and all practitioners with the necessary clinical, evolutionary, radiological, biological and histological elements to avoid diagnostic errors. This is a retrospective study of all patients who were hospitalized for necrotizing otitis in the department of otolaryngology of the hospital of specialties of Rabat spread over a period of 5 years. All patients received an admission CT scan, biological tests, bacteriological sampling and biopsy. As well as initial parenteral antibiotic therapy and surgery for incidentally discovered EAC carcinomas. Clinically, all patients had otalgia and granulation tissue on otoscopic examination under the microscope. 50% had otorrhea. Pseudomonas aeruginosa was isolated in 50% of the cases, staphylococcus aureus in 25% and sterile culture in 25%. From the first biopsy, the diagnosis of tumor was retained in 6/10 patients. A second biopsy was performed in patients who did not show improvement and had a sterile culture. This one allowed the diagnosis in 4 other patients. All our patients had a surgical indication and were operated and then irradiated. The survival at 5 years was 50%. Biopsy must be systematic for every patient hospitalize for necrotizing otitis. Without hesitating to do it again each time the evolution is not good and the culture is sterile.
Objective
To determine the diagnostic accuracy of Necrotizing Otitis Externa (NOE) based on radiologic studies.
Methods
The PubMed, Cochrane, Embase, Web of Science, SCOPUS, and Google Scholar databases were searched. True-positive and false-negative results were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool.
Results
The included studies contained data on 37 studies diagnosed with NOE. The sensitivity of gallium-67, technetium-99m, and Magnetic Resonance Imaging (MRI) was 0.9378 (0.7688–0.9856), 0.9699 (0.8839–0.9927), and 0.9417 (0.6968–0.9913), respectively. For Computed Tomography (CT), the positive criteria consisted of bony erosion alone and bony erosion plus any soft tissue abnormality. The sensitivity of CT based only on bony erosion was 0.7062 (0.5954–0.7971); it was higher 0.9572 (0.9000–0.9823) when based on bony erosion plus any soft tissue abnormality.
Conclusion
The diagnostic sensitivity of technetium-99m, gallium-67, and MRI was favorable. On CT, the presence of bony erosion may be a useful diagnostic marker of NOE, but the diagnostic sensitivity will be even higher if the criterion of any soft tissue abnormality is also included; however, care should be taken when interpreting the results. Our study demonstrates the potential utility of radiology studies for diagnosing NOE, but their lack of specificity must be considered, and standardized anatomic criteria are still needed.
Level of evidence
2A.
