Necrotizing external otitis: diagnostic clues in the emergency department.

Autor: Vaca M; Department of Otolaryngology, Hospital Universitario Ramón Y Cajal, Ctra. Colmenar Km 9.100, 28034, Madrid, Spain. miguel.vaca.gonzalez@gmail.com., Medina MM; Department of Otolaryngology, Hospital Universitario Ramón Y Cajal, Ctra. Colmenar Km 9.100, 28034, Madrid, Spain., Cordero AI; Department of Otolaryngology, Hospital Universitario Ramón Y Cajal, Ctra. Colmenar Km 9.100, 28034, Madrid, Spain., Polo R; Department of Otolaryngology, Hospital Universitario Ramón Y Cajal, Ctra. Colmenar Km 9.100, 28034, Madrid, Spain., Pérez C; Department of Otolaryngology, Hospital Universitario Ramón Y Cajal, Ctra. Colmenar Km 9.100, 28034, Madrid, Spain., Domínguez S; Department of Otolaryngology, Hospital Universitario Ramón Y Cajal, Ctra. Colmenar Km 9.100, 28034, Madrid, Spain., de Los Santos G; Department of Otolaryngology, Hospital Universitario Ramón Y Cajal, Ctra. Colmenar Km 9.100, 28034, Madrid, Spain.
Jazyk: angličtina
Zdroj: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery [Eur Arch Otorhinolaryngol] 2024 Feb; Vol. 281 (2), pp. 737-742. Date of Electronic Publication: 2023 Aug 07.
DOI: 10.1007/s00405-023-08178-4
Abstrakt: Purpose: The assessment of necrotizing external otitis requires a high index of suspicion by the attending physician. The purpose of the study is to determine the accuracy of parameters available at the Emergency Department for the diagnosis of this pathology.
Methods: Retrospective diagnostic accuracy study. Patients consulting at the Emergency Department for longstanding ear swelling, severe otalgia, and failure to respond to topical treatment were included. Otoscopy, physical examination, CT appearance, and analytical results were tested for the diagnosis of necrotizing external otitis, using nuclear imaging as gold standard. Sensitivity, specificity, likelihood ratios and ROC curves were calculated.
Results: 24 patients were included; 13 cases were necrotizing external otitis, and 11 cases were other external ear pathologies. Erythrocyte sedimentation rate and C-reactive protein levels were significantly associated with necrotizing external otitis (AUC 0.92 p < 0.001, and 0.8 p < 0.001). Positive likelihood ratios were 10.15 for values of erythrocyte sedimentation rate over 26 mm/h, and 8.25 for C-reactive protein levels over 10 mg/L. Negative likelihood ratios were 0.08 and 0.28, respectively. These results were significant. The rest of clinical and radiological parameters were less accurate.
Conclusions: Erythrocyte sedimentation rate and C-reactive protein are useful parameters in the evaluation of a case of longstanding otitis with clinical suspicion of necrotizing external otitis. If any of them is elevated, the probability of suffering this condition is significantly increased. If they are within normal ranges, an alternative diagnosis should be sought.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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