目的:我们旨在介绍坏死性外耳道炎(NOE)患者早期和长期随访的治疗方法及其合并症。
方法:在2011年至2022年之间,30例诊断为NEO的患者,在颞骨计算机断层扫描中出现皮质骨侵蚀或小梁脱矿并接受至少6周抗菌治疗的患者被纳入研究.临床,患者的实验室和影像学检查结果,并对随访期间的合并症进行了分析。在磁共振成像上,NOE从枕骨裂处进一步延伸被接受为内侧颅底(MSB)受累。
结果:30名患者,(8个女人,22人,平均年龄66.2±1.7),NOE患者随访36.4±29.6个月。死亡率为23.33%,平均生存时间为12.37±11.35个月。重复培养显示5名患者(20%)的新病原体或第二病原体。在4例和12例患者中观察到严重和深度的感觉神经性听力损失(SNHL),分别。在随访期间,6名存活的SNHL严重患者中有3名出现骨化性迷路炎。慢性病贫血(CDA)(66.66%),脑血管疾病(CVD)(43.33%),慢性肾功能衰竭(CRF)(30%),视网膜病变(26.66%)是NOE患者最常见的合并症。颅神经麻痹(CNP)(P<0.001),SNHL(P<0.04),CDA(P<0.005),和死亡率(P<0.022)与MSB受累存在显著相关。
结论:NOE是一种需要长期随访的疾病,导致严重的发病率,死亡率很高。MSB参与与CNP有关,SNHL和骨化性迷路炎。此外,CDA,CVD,CRF和视网膜病变是需要治疗的最常见的合并症。
OBJECTIVE: We aimed to present the management of the patients with necrotizing otitis externa (NOE) and its comorbidities in early and long-term follow-up.
METHODS: Between 2011 and 2022, 30 patients with the diagnose of NEO, who had cortical bone erosion or trabecular demineralization in temporal bone computed tomography and administered at least 6-week antimicrobial therapy were included in the study. Clinical, laboratory and imaging findings of patients, and comorbidities during follow-up were analysed. NOE extending further from the petro-occipital fissure on magnetic resonance imaging was accepted as medial skull base (MSB) involvement.
RESULTS: 30 patients, (8 women, 22 men, mean age 66.2 ± 1.7), with NOE were followed 36.4 ± 29.6 months. The mortality rate was 23.33% and the mean survival time was 12.37 ± 11.35 months. Repeated cultures reveal a new or second pathogen in 5 patients (20%). Severe and profound sensorineural hearing loss (SNHL) were observed in 4 and 12 patients, respectively. Labyrinthitis ossificans emerged in 3 of 6 surviving patients with profound SNHL during follow-up. Chronic disease anemia (CDA) (66.66%), cerebrovascular disease (CVD) (43.33%), chronic renal failure (CRF) (30%), and retinopathy (26.66%) were the most frequent comorbidities in patients with NOE. Cranial nerve paralysis (CNP) (P < 0.001), SNHL (P < 0.04), CDA (P < 0.005), and mortality (P < 0.022) were significantly associated with the presence of MSB involvement.
CONCLUSIONS: NOE is a disease that requires long-term follow-up, causes severe morbidity, and has a high mortality rate. MSB involvement is associated with CNP, SNHL and labyrinthitis ossificans. Moreover, CDA, CVD, CRF and retinopathy are the most common comorbitidies needed to be managed.