91 Malignant Otitis Extern A

7/24/2019 91 Malignant Otitis Extern A

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Malignant external otitisMalignant external otitisNecrotizing external otitisNecrotizing external otitis

Dr. WASEEM WATADDr. WASEEM WATAD



Case 1.Case 1. ( SH. Y )( SH. Y )

80 years old80 years old 3VD , PTCA , DM-tye! , HT" , #PH3VD , PTCA , DM-tye! , HT" , #PH

E$t. ot%t%s &%t' P A# a*d ear drosE$t. ot%t%s &%t' P A# a*d ear dros&%t' %+roe+e*t seeral +o*t's&%t' %+roe+e*t seeral +o*t'seore ad+%ss%o*eore ad+%ss%o*

seere /t. otal%a , a%al a%* /t. , a*dseere /t. otal%a , a%al a%* /t. , a*d

/t. arot%d +ass at ad+%ss%o* 120204/t. arot%d +ass at ad+%ss%o* 120204 /t ear d%s'are/t ear d%s'are We%'t lossWe%'t loss



Case 1.Case 1.

CT sa* (!00204)5 /t arot%d +ass ,CT sa* (!00204)5 /t arot%d +ass ,%*6ltrat%o* o ara'ary*eal at , EAC ,%*6ltrat%o* o ara'ary*eal at , EAC ,%*rate+oral ossa , /t. lat. teryo%d a*d%*rate+oral ossa , /t. lat. teryo%d a*d

+asseter .*o o*y eros%o* a*d *o+asseter .*o o*y eros%o* a*d *oly+'ade*oat'yly+'ade*oat'y

M/7 (121004) 5roess %*6ltrat%* t'e /t.M/7 (121004) 5roess %*6ltrat%* t'e /t.ear,te+oral o*e , TM, s'e*o%d s%*9s ,ear,te+oral o*e , TM, s'e*o%d s%*9s ,

%*rate+oral ossa a*d%*rate+oral ossa a*d skull baseskull base #%osy o EAC oly, arot%d :"A (!81004) ;#%osy o EAC oly, arot%d :"A (!81004) ;

+%$ed %*<a++at%o*+%$ed %*<a++at%o* Pos%t%e 9lt9re or . aer9%*osaPos%t%e 9lt9re or . aer9%*osa



Case 1.Case 1.

7V A# treat+e*t ( e'alosor%*e7V A# treat+e*t ( e'alosor%*e

a*d =9%*olo*es ) &%t' ear drosa*d =9%*olo*es ) &%t' ear dros

a*d to%lettea*d to%lette 7+roe+e*t %* a%* , ear7+roe+e*t %* a%* , ear

d%s'ared%s'are

T'ere &as *o C" %*ole+e*t T'ere &as *o C" %*ole+e*t



Case !. (Case !. ( Va. DVa. D ))

>8 years old>8 years old

DM-tye ! , HT"DM-tye ! , HT"

Hyerl%%de+%a , s CVAHyerl%%de+%a , s CVA /t. "aso'ary*eal +ass ; %osy *o/t. "aso'ary*eal +ass ; %osy *o

+al%*a*y (1104)+al%*a*y (1104)

#%l. E$t. ot%t%s 0204 ( seeral &ee?s#%l. E$t. ot%t%s 0204 ( seeral &ee?s

eore ad+%tt%o* ) rolo* A# treat+e*teore ad+%tt%o* ) rolo* A# treat+e*t

( se+%-sy*t'et% e*%%ll%* , =9%*olo*e) a*d( se+%-sy*t'et% e*%%ll%* , =9%*olo*e) a*d

ear drosear dros



Case !.Case !.

"o %+roe+e*t"o %+roe+e*t

/t. Seere otal%a , ear d%s'are ,/t. Seere otal%a , ear d%s'are ,

ers%ste*t rt. e$t. ot%t%s , &%t'ers%ste*t rt. e$t. ot%t%s , &%t'ra*9lat%o* t%ss9era*9lat%o* t%ss9e

Eleated ES/ , *eat%e 9lt9re or .Eleated ES/ , *eat%e 9lt9re or .

aer9%*osaaer9%*osa

Start 7V eta@%d%+e ( &ee?s )Start 7V eta@%d%+e ( &ee?s )

Proress%o* 6*d%*s %* ser%al CTM/7Proress%o* 6*d%*s %* ser%al CTM/7



Case !.Case !.

CT sa* ( 141104 ) - %*6ltrat%o* o t'eCT sa* ( 141104 ) - %*6ltrat%o* o t'ert. ara'ary*eal sae , rt. Masto%drt. ara'ary*eal sae , rt. Masto%d

a*d +%ddle ear, %*6ltrat%* oa*d +%ddle ear, %*6ltrat%* o%*rate+oral ossa%*rate+oral ossa M/7 ( !4!104 ) ; lare +ass %* rt.M/7 ( !4!104 ) ; lare +ass %* rt.

ara'ary*eal sae &%t' %*ole+e*tara'ary*eal sae &%t' %*ole+e*t

o rt. TM a*d dee loe o rt. Parot%so rt. TM a*d dee loe o rt. Parot%s CT (010) %*6ltrat%* %* rt. TMCT (010) %*6ltrat%* %* rt. TM



Case !.Case !.

De’bridmentDe’bridment -- (10/01/05) ,(10/01/05) ,.. (24/01/05),(24/01/05), Hx – infammatr! tissueHx – infammatr! tissue 2 "eeks # $%&'$& * %+++%2 "eeks # $%&'$& * %+++%

+xaerbatin # t. talia , ear disare and+xaerbatin # t. talia , ear disare andrelase # ranulatin tissue # +$relase # ranulatin tissue # +$ 3reatment #ailure 3reatment #ailure urter tera! 6urter tera! 6

; 7rad setrum # $78 – mbinatin #7rad setrum # $78 – mbinatin #ealsrines and 9uinlneealsrines and 9uinlne

; :urial treatment – mastidetm! */-:urial treatment – mastidetm! */-t!manlast! , ablatin # ranulatin andt!manlast! , ablatin # ranulatin andnerti;in tissue, bne and artilaenerti;in tissue, bne and artilaese9uestratinsse9uestratins

; H7H7



Temporal

Maxilla

Parietal

Sphenoid

Frontal

Z

Lat. Pterygoid Plate

Pterygomaxillary Fissure

Infratemporal Fossa



ME - r%ter%aME - r%ter%a

SadeB (1282) 5SadeB (1282) 5; Seere ET. ot%t%s 9*reso*s%e to at least 10 days oSeere ET. ot%t%s 9*reso*s%e to at least 10 days o

o*serat%e treat+e*to*serat%e treat+e*t;

7*reas%* ao*%@%* a%* e$aerated at *%'t7*reas%* ao*%@%* a%* e$aerated at *%'t; ra*9lat%o* t%ss9e %* t'e ase o EACra*9lat%o* t%ss9e %* t'e ase o EAC; /eeated %solat%o* o se9do+o*as/eeated %solat%o* o se9do+o*as

ee*so* (1221) 5ee*so* (1221) 5; /eratory ot%t%s e$t./eratory ot%t%s e$t.; Seere otal%a , &orse at *%'tSeere otal%a , &orse at *%'t; P9r9le*t e$9date , ra*9lat%o* t%ss9eP9r9le*t e$9date , ra*9lat%o* t%ss9e; /eoery o P. aer9%*osa/eoery o P. aer9%*osa; DM , %++9*e state o+ro+%seDM , %++9*e state o+ro+%se; Pos%t%e T-22 o*e sa* o te+oral o*ePos%t%e T-22 o*e sa* o te+oral o*e



et%oat'oe*es%set%oat'oe*es%s



ME - sta%*ME - sta%*

Corey (128) 5Corey (128) 5; 7 - 7*et%o* o o*e a*d sot t%ss9e7 - 7*et%o* o o*e a*d sot t%ss9e

&%t'o9t ra*%al *eres les%o*s or&%t'o9t ra*%al *eres les%o*s or%*trara*%al les%o*s%*trara*%al les%o*s

; 7777 - ra*%al *ere aralys%s- ra*%al *ere aralys%s a- V77 aralys%s o*lya- V77 aralys%s o*ly

- M9lt%le ra*%al *eres aralys%s- M9lt%le ra*%al *eres aralys%s; 777 ; +e*%*%t%s , e%d9ral e+ye+a ,777 ; +e*%*%t%s , e%d9ral e+ye+a ,

s9d9ral e+ye+a or ra%* asesss9d9ral e+ye+a or ra%* asess



"E - d%a*os%s"E - d%a*os%s

Cl%*%al 6*d%*sCl%*%al 6*d%*s

aoratory testsaoratory tests

C9lt9reC9lt9re

a->, T-22 sa*sa->, T-22 sa*s

H/-CT &%t' o*trastH/-CT &%t' o*trast #%osy o ra*9lat%o* t%ss9e#%osy o ra*9lat%o* t%ss9e



+ortal%ty+ortal%ty

4>F (12>8)4>F (12>8)

10F ree*t art%les10F ree*t art%les

H%' +ortal%ty %* a%al *. aralys%sH%' +ortal%ty %* a%al *. aralys%s



Ma*ae+e*t ; o*t.Ma*ae+e*t ; o*t.

H/-CT o*trast eal9at%o*H/-CT o*trast eal9at%o* a-> (eery 4 &ee?s) ollo& 9 &%t'a-> (eery 4 &ee?s) ollo& 9 &%t'

treat+e*ttreat+e*t Ma*ae+e*t 9*derly%* roess ( DM Ma*ae+e*t 9*derly%* roess ( DM %++9*os9ress%e)%++9*os9ress%e)

S9r%al deBr%d+e*t ,dr%*ae ;S9r%al deBr%d+e*t ,dr%*ae ;

%*trara*%al e$t. , ra%* asess%*trara*%al e$t. , ra%* asess > &ee?s o A# , reeat 9lt9res , oral A#> &ee?s o A# , reeat 9lt9res , oral A#ater ! &ee?s o essat%o* o sy+to+sater ! &ee?s o essat%o* o sy+to+s



Ma*ae+e*t ; o*t.Ma*ae+e*t ; o*t.

Dee %osy o ra*9lat%o* t%ss9e ;Dee %osy o ra*9lat%o* t%ss9e ;

9*derly%* ar%*o+a9*derly%* ar%*o+a



T'erae9t% role+s T'erae9t% role+s

Ma%* role+ %s 5Ma%* role+ %s 5

; C'o%e o t'e A#C'o%e o t'e A#

; D9rat%o* o treat+e*tD9rat%o* o treat+e*t




D9rat%o* o treat+e*tD9rat%o* o treat+e*t

; Sta*dard %*d%at%o* ( >-8 &ee?s )Sta*dard %*d%at%o* ( >-8 &ee?s )

; 7de*t%y%* oGet%e ara+eter o7de*t%y%* oGet%e ara+eter ode6*%t%e reoeryde6*%t%e reoery Heal%* o s?%* EACHeal%* o s?%* EAC

ES/ES/ a->a->




S9r%al treat+e*t 5S9r%al treat+e*t 5

; Co+le+e*tary roleCo+le+e*tary role

; Masto%deto+y - ty+a*olastyMasto%deto+y - ty+a*olasty

; /eo++e*dat%o* ; %osy ,/eo++e*dat%o* ; %osy ,

lea*s%* , alat%o* o *erot%@%* a*dlea*s%* , alat%o* o *erot%@%* a*d

ra*9lat%o* t%ss9e a*d t'e o*e ,ra*9lat%o* t%ss9e a*d t'e o*e ,art%lae se=9estrat%o*sart%lae se=9estrat%o*s




Hyerar% o$ye* t'erayHyerar% o$ye* t'eray

; Da%ly , !.4-3 at+, 20 +%*9tea , 30Da%ly , !.4-3 at+, 20 +%*9tea , 30

o9rseso9rses

; 7*d%at%o*s 5 ada*ed staes ,7*d%at%o*s 5 ada*ed staes ,

re9rre*t ases, reratory to A#re9rre*t ases, reratory to A#; Hyo$%a %+a%red o$ye* dee*de*tHyo$%a %+a%red o$ye* dee*de*t

ater%al ?%ll%* y 'aoytos%sater%al ?%ll%* y 'aoytos%s

91 Malignant Otitis Extern A

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