Endocrine Abstracts

Aims

Necrotizing external otitis (NEO) is osteomyelitis of the base of the skull. Previously Pseudomonas Aeruginosa was incriminated in 90% of cases. However, fungal NEO have been emerging in recent years. It is a pathology that occurs primarily in immunocompromised terrain such as diabetic and may affect the patient’s functional and vital prognosis.

Materials and methods

A retrospective study of 20 cases of fungal NEO conducted at Sousse ENT department over an 11-year period (2006–2016).

Results

The average age of the patients was 67 years (3 to 90 years). The sex ratio was 1.7. 80% of our patients were diabetic. The average time to diagnosis was of 27 days. The most common clinical signs were intense and sleepless otalgia resistant to medical treatment present in all our patients and otorrhea in 45% of cases. A peripheral facial palsy was present in 5 cases. An infectious biological check-up has been requested in all our patients and has objectified breeding of VS and CRP. A brain and temporal ct scan was performed in all of our patients and showed osteolysis signs in all our patients: endocrine extension was present in 15% of cases, mastoiditis in 25% of cases, extension to deep spaces in 5% of cases and to the parotid lodge in 5% of cases. All our patients have had bacteriological and mycological samplings at admission with initial probabilistic antibiotherapy anti pyocyanic, diabetes balance and local care. Mycosic origin was confirmed in 19 cases following of mycological samples or histological examination. The sample was negative in one case. The germs found were Candida (47%), Aspergillus sp (47%), and rhizopusoryzae (6%). Pseudomonas aeruginosa was associated in one case. The lack of improvement under antibiotic treatment, the negativity of bacteriological samples as well as mycological results led us to implement an antifungal treatment. The evolution was favorable in 14 patients, 2 were referred for hyperbaric oxygen therapy, 2 were lost of sight and 2 were patients died during treatment.

Conclusion

Diagnosis of mycosic origin of fungal SDO difficult to isolate agent response. The negativity of bacteriological samples and the lack of response to treatment encourages us to take mycological samples. Despite the negativity of these, we are always able to prescribe antifungals as early as possible to preserve the functional and vital prognosis of patients with debilitated terrain.