Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-02T19:02:01.091Z Has data issue: false hasContentIssue false
  • English
  • Français

Temporomandibular joint involvement as a positive clinical prognostic factor in necrotising external otitis

Published online by Cambridge University Press:  15 March 2016

E Yeheskeli ,
R Abu Eta ,
H Gavriel ,
S Kleid  and
E Eviatar
E Yeheskeli
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
R Abu Eta
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
H Gavriel*
Affiliation:
Department of Surgical Oncology, Peter MacCallum Cancer Institute, Melbourne, Australia
S Kleid
Affiliation:
Department of Surgical Oncology, Peter MacCallum Cancer Institute, Melbourne, Australia
E Eviatar
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
*
Address for correspondence: Dr Haim Gavriel, Department of Surgical Oncology, Peter MacCallum Cancer Institute, Melbourne, Australia E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Necrotising otitis externa is associated with high morbidity and mortality rates. This study investigated whether temporomandibular joint involvement had any prognostic effect on the course of necrotising otitis externa in patients who had undergone hyperbaric oxygen therapy after failed medical and sometimes surgical therapy.

Methods:

A retrospective case series was conducted of patients in whom antibiotic treatment and surgery had failed, who had been hospitalised for further treatment and hyperbaric oxygen therapy.

Results:

Twenty-three patients with necrotising otitis externa were identified. The temporomandibular joint was involved in four patients (17 per cent); these patients showed a constant gradual improvement in C-reactive protein and were eventually discharged free of disease, except one patient who was lost to follow up. Four patients (16 per cent) without temporomandibular joint involvement died within 90 days of discharge, while all patients with temporomandibular joint involvement were alive. Three patients (13 per cent) without temporomandibular joint involvement needed recurrent hospitalisation including further hyperbaric oxygen therapy; no patients with temporomandibular joint involvement required such treatment.

Conclusion:

Patients with temporomandibular joint involvement had lower rates of recurrent disease and no mortality. Therefore, we suggest considering temporomandibular joint involvement as a positive prognostic factor in necrotising otitis externa management.

Keywords

Temporomandibular JointExternal OtitisPrognosisHyperbaric Oxygen TherapyTherapeutics
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 5 , May 2016 , pp. 435 - 439
Copyright
Copyright © JLO (1984) Limited 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Ozgen, B, Oguz, KK, Cila, A. Diffusion MR imaging features of skull base osteomyelitis compared with skull base malignancy. AJNR Am J Neuroradiol 2011;32:179–84CrossRefGoogle ScholarPubMed
2 Rubin, J, Yu, VL. Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnoses, and therapy. Am J Med 1988;85:391–8Google Scholar
3 Sreepada, GS, Kwartler, JA. Skull base osteomyelitis secondary to malignant otitis externa. Curr Opin Otolaryngol Head Neck 2003;11:316–23Google Scholar
4 Carfrae, MJ, Kesser, BW. Malignant otitis externa. Otolaryngol Clin North Am 2008;537:41–9Google Scholar
5 Slattery, WH III, Brackmann, DE. Skull base osteomyelitis. Malignant external otitis. Otolaryngol Clin North Am 1996;29:795–806 CrossRefGoogle ScholarPubMed
6 Timon, CI, O'Dwyer, T. Diagnosis, complications, and treatment of malignant otitis externa. Ir Med J 1989;82:30–1Google Scholar
7 Mardinger, O, Rosen, D, Minkow, B, Tulzinsky, Z, Ophir, D, Hirshberg, A. Temporomandibular joint involvement in malignant external otitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:398–403 CrossRefGoogle ScholarPubMed
8 Adams, A, Offiah, C. Central skull base osteomyelitis as a complication of necrotizing otitis externa: imaging findings, complications, and challenges of diagnosis. Clin Radiol 2012;67:e7–16 Google Scholar
9 Loh, S, Loh, WS. Malignant otitis externa: an Asian perspective on treatment outcomes and prognostic factors. Otolaryngol Head Neck Surg 2013;148:991–6CrossRefGoogle ScholarPubMed
10 Midwinter, KI, Gill, KS, Spencer, JA, Fraser, ID. Osteomyelitis of the temporomandibular joint in patients with malignant otitis externa. J Laryngol Otol 1999;113:451–3CrossRefGoogle ScholarPubMed
11 Thompson, HG. Septic arthritis of the temporomandibular joint complicating otitis externa. J Laryngol Otol 1989;103:319–21CrossRefGoogle Scholar
12 Doroghazi, RM, Nadol, JB Jr, Hyslop, NE, Baker, AS, Axelrod, L. Invasive external otitis. Report of 21 cases and review of the literature. Am J Med 1981;71:603–14Google Scholar
13 Mendez, G Jr, Quencer, RM, Post, MJ, Stokes, NA. Malignant external otitis: a radiographic-clinical correlation. AJR Am J Roentgenol 1979;132:957–61CrossRefGoogle ScholarPubMed
14 Dingle, AF. Fistula between the external auditory canal and the temporomandibular joint: a rare complication of otitis externa. J Laryngol Otol 1992;106:994–5Google Scholar
15 Drew, SJ, Himmelfarb, R, Sciubba, JJ. Invasive (malignant) external otitis progressing to osteomyelitis of the temporomandibular joint: a case report. J Oral Maxillofac Surg 1993;51:429–31Google Scholar
16 Rojas Casanova, P, Pila Perez, R, Dieguez Tejada, R, Pila Pelaez, M. Malignant otitis externa with dysfunction of the temporomandibular articulation [in Spanish]. Acta Otorrinolaringol Esp 1993;44:235–8Google ScholarPubMed
17 Meltzer, PE, Kellemen, G. Pyocyaneous osteomyelitis of the temporal bone, mandible and zygoma. Laryngoscope 1959;69:1300–16CrossRefGoogle Scholar
18 Sano, K, Asoh, H, Yoshida, S, Inokuchi, T. Preauricular mass presenting as a sign of osteomyelitis of the temporal bone. J Oral Maxillofac Surg 1998;56:1349–52Google Scholar
19 Schweitzer, VG. Hyperbaric oxygen management of chronic staphylococcal osteomyelitis of the temporal bone. Am J Otol 1990;11:347–53Google ScholarPubMed
20 Wang, RG, Bingham, B, Hawke, M, Kwok, P, Li, JR. Persistence of the foramen of Huschke in the adult: an osteological study. J Otolaryngol 1991;20:251–3Google Scholar
21 Ars, B. Huschke's foramen [in French]. Acta Otorhinolaryngol Belg 1988;42:654–8Google ScholarPubMed
22 Faig-Leite, H, Horta Júnior, JA. Persistence of the foramen of Huschke. Dent Res 1999;77:1177 Google Scholar
23 Herzog, S, Fiese, R. Persistent foramen of Huschke: possible risk factor for otologic complications after arthroscopy of the temporomandibular joint. Oral Surg Oral Med Oral Pathol 1989;68:267–70Google Scholar