220. Malignant External Otitis : Comparative Study
Session: Poster Abstract Session: Candida Infection
Thursday, October 8, 2015
Room: Poster Hall
  • P 220.pdf (82.1 kB)
  • Background: Malignant external otitis (MEO) or necrotizing external otitis, is an aggressive and potentially fatal infection. It originates in the external ear canal, spreads progressively along the soft tissues and bone and may subsequently involve intracranial structures. Fungi are rarely isolated. We aim to investigate clinical characteristics and outcome in fungal MEO.

    Methods: We included in retrospective study, 54 patients admitted in the Department of Infectious Diseases between 1995 and 2013. We compared clinical and radiological findings as well as therapeutic regimens between patients with fungal MEO (G1=18; 33.3%) and non fungal MEO patients (G2=36; 66.7%).

    Results: The mean age was 68.2±10 in G1 and 58.7±15 in G2 (p=0.02). There were as men as women in G1. Diabetes was significantly associated with fungal MEO (94.4 vs. 66.7%; p=0.04 and OR=8.5). Degenerative complications of diabetes were revealed in 61.1% among patients in G1 (vs. 22.2% in G2; p=0.005 and OR=5.5). Topical steroids were more frequently used in G1 (50 vs. 5.5%; p<0.0001 and OR=17). Dizziness and tinnitus were revealed predominantly in G1 (33.3 vs. 11.1% p=0.04, OR=4 and 50 vs. 19.4%; p=0.02, OR=4.1 respectively). Bilateral disease was listed in 2 patients in each group (p=0.6). A mastoid pain was frequently described in G1 (88.9 vs. 38.9%; p=0.001 and OR=12.5). Temporomandibular joint was painful mostly in G1 patients (33.3 vs. 8.3%; p=0.04 and OR=5.5). Hemoglobin was lower in G1 (11.3±1 vs. 12.8±2 g/dL; p=0.01). Bone destruction was found in 72.2% of cases in G1 (vs. 44.4% in G2; p=0.05). Candida spp. was the main germ (77.8%) while Aspergillus spp. was isolated in 27.8%. Mean duration of treatment were longer in G1 (60.8±27days vs. 36.7±18 days; p=0.002). Poor outcome was more frequent in G1 (44.4 vs. 11.1%; p 0.012) and complications rate was 22.2% in G1 (vs. 2.8% in G2; p=0.038 and OR= 10). Two patients with fungal MEO died.

    Conclusion: We concluded that fungal MEO are more likely to affect elderly and diabetic patients. This entity is known to be more invasive and may lead to severe clinical and radiological complications. Suitable treatment should be quickly started and maintained longtime to improve its prognosis.

    Houda Ben Ayed, MD1, Makram Koubaa, MD1, Sahar Ben Kahla, MD1, Boussaima Hammami, MD1, Chakib Marrakchi, MD1, Moncef Sellami, MD2, Monoem Ghorbel, MD2 and Mounir Ben Jemaa, MD1, (1)Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax, Tunisia, (2)Department of Otolaryngology Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia


    H. Ben Ayed, None

    M. Koubaa, None

    S. Ben Kahla, None

    B. Hammami, None

    C. Marrakchi, None

    M. Sellami, None

    M. Ghorbel, None

    M. Ben Jemaa, None

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