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Ruth Hardoff - One of the best experts on this subject based on the ideXlab platform.
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semiquantitative skull planar and spect bone scintigraphy in diabetic patients differentiation of necrotizing malignant External Otitis from severe External Otitis
The Journal of Nuclear Medicine, 1994Co-Authors: Ruth Hardoff, Nechama Uri, Sara Gips, Avi Front, Ada TamirAbstract:UNLABELLED Early diagnosis of necrotizing External Otitis (NEO) includes the use of bone scintigraphy since clinical assessment alone cannot differentiate the necrotizing type of Otitis from the severe type of External Otitis in which there is no extension to the adjacent bone. Four-hour planar bone scintigraphy may reflect soft-tissue infection, and therefore may not be useful in distinguishing NEO from severe External Otitis (SEO). Twenty-four-hour bone scintigraphy using planar or SPECT imaging may better reflect bone uptake and increase the accuracy of the test. METHODS Twenty-six diabetic patients (12 diagnosed NEO; 14 SEO) and 10 nondiabetic (ND) patients were studied. Lesion-to-nonlesion (L/N) count ratios obtained from planar and SPECT imaging at 4 hr, 24 hr and 24 hr/4 hr (24/4) were assessed. RESULTS Count ratios obtained from the 4- and 24-hr planar and SPECT images were significantly higher in the NEO patients compared to SEO patients for both planar and SPECT studies (p < 0.001, 0.005). The 24/4 count ratio was also significantly higher in the NEO patients on the planar (p < 0.01) and the SPECT studies (p < 0.001). The ND patients were not different from SEO patients on 4-hr planar, 4- and 24-hr SPECT as well as 24/4-hr planar and SPECT studies. The L/N count ratio threshold yielding the best sensitivity for detecting NEO was 1.05 for the 24/4 SPECT study. CONCLUSION In diabetic patients, an early distinction between NEO and SEO patients can be reliably made by using L/N count ratios on 24/4 or 24-hr SPECT bone scintigraphy.
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Quantitative bone and 67Ga scintigraphy in the differentiation of necrotizing External Otitis from severe External Otitis.
Archives of otolaryngology--head & neck surgery, 1991Co-Authors: Nechama Uri, Sara Gips, Avi Front, Shlomo Walter Meyer, Ruth HardoffAbstract:• Qualitative technetium Tc 99m bone scintigraphy using phosphate compounds and gallium 67 scintigraphy were described as a helpful means in diagnosing necrotizing External Otitis (NEO). They were, however, claimed to be nonspecific. Quantitative Tc 99m methylene diphosphonate bone scintigraphy and gallium 67 scintigraphy were performed in eight patients with NEO and in 20 patients with severe External Otitis, in order to prove usefulness of scintigraphy in the diagnosis of NEO. Ratios of lesion to nonlesion for bone scintigraphy were 1.67 ± 0.16 in patients with NEO and 1.08 ± 0.09 in patients with severe External Otitis, and for gallium 67 scintigraphy they were 1.35 ± 0.24 in NEO patients and 1.05 ± 0.03 in patients with severe External Otitis. There was no difference in uptake between diabetic patients with severe External Otitis and nondiabetic patients. The scintigraphic studies were also evaluated using a qualitative scoring method (scores 0 to +4), according to the intensity of the radiopharmaceutical uptake. This method was found to be inferior in the diagnosis of NEO compared with the quantitative method. We conclude that lesion-to-nonlesion ratios greater than 1.5 and 1.3 on bone and gallium 67 scintigraphy, respectively, are indicative of NEO. Quantitative bone scintigraphy, which is quicker to perform, may be used as a single imaging modality for the diagnosis of NEO. ( Arch Otolaryngol Head Neck Surg . 1991;117:623-626)
Yazdan Yazdanpanah - One of the best experts on this subject based on the ideXlab platform.
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Aspergillus flavus malignant External Otitis in a diabetic patient: case report and literature review
Infection, 2020Co-Authors: Maud Pichon, Véronique Joly, Nicolas Argy, Sandrine Houze, Stéphane Bretagne, Alexandre Alanio, Michel Wassef, Benjamin Verillaud, Yazdan YazdanpanahAbstract:Purpose Malignant External Otitis is an aggressive and potentially life-threatening infection. This rare disorder is typically caused by Pseudomonas aeruginosa and affects almost exclusively elderly diabetic patients. However, fungal malignant External Otitis have been identified, especially in immunocompromised hosts. Methods We report a rare case of invasive malignant External Otitis caused by Aspergillus flavus in a diabetic patient without other underlying immunosuppression. A review of Aspergillus spp . malignant External Otitis since voriconazole became the first line for invasive aspergillosis was performed. Results A 72-year-old man with diabetes mellitus developed invasive malignant External Otitis with a vascular involvement. The patient was treated with empiric courses of antibiotics until a fungal infection was diagnosed. Proven Apsergillus infection was based on histopathological examination and isolation of A. flavus from culture of osteo-meningeal biopsies. Despite optimal antimicrobial therapy with voriconazole, the patient presented with cerebral infarction in the setting of an angioinvasive fungal infection leading to a fatal outcome. From a review of the literature, we found 39 previously published cases of proven Aspergillus spp . malignant External Otitis treated with new triazoles. Conclusion Given our experience and the literature review, a fungal etiology should be considered early in the course of malignant External Otitis unresponsive to a conventional broad spectrum antibiotic therapy, with the need for a tissue biopsy to confirm the diagnosis.
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Aspergillus flavus malignant External Otitis in a diabetic patient: case report and literature review
Infection, 2020Co-Authors: Maud Pichon, Véronique Joly, Nicolas Argy, Sandrine Houze, Stéphane Bretagne, Alexandre Alanio, Michel Wassef, Benjamin Verillaud, Yazdan YazdanpanahAbstract:Malignant External Otitis is an aggressive and potentially life-threatening infection. This rare disorder is typically caused by Pseudomonas aeruginosa and affects almost exclusively elderly diabetic patients. However, fungal malignant External Otitis have been identified, especially in immunocompromised hosts. We report a rare case of invasive malignant External Otitis caused by Aspergillus flavus in a diabetic patient without other underlying immunosuppression. A review of Aspergillus spp. malignant External Otitis since voriconazole became the first line for invasive aspergillosis was performed. A 72-year-old man with diabetes mellitus developed invasive malignant External Otitis with a vascular involvement. The patient was treated with empiric courses of antibiotics until a fungal infection was diagnosed. Proven Apsergillus infection was based on histopathological examination and isolation of A. flavus from culture of osteo-meningeal biopsies. Despite optimal antimicrobial therapy with voriconazole, the patient presented with cerebral infarction in the setting of an angioinvasive fungal infection leading to a fatal outcome. From a review of the literature, we found 39 previously published cases of proven Aspergillus spp. malignant External Otitis treated with new triazoles. Given our experience and the literature review, a fungal etiology should be considered early in the course of malignant External Otitis unresponsive to a conventional broad spectrum antibiotic therapy, with the need for a tissue biopsy to confirm the diagnosis.
Mark J. Levenson - One of the best experts on this subject based on the ideXlab platform.
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Necrotizing 'malignant' External Otitis caused by Staphylococcus epidermidis.
Archives of otolaryngology--head & neck surgery, 1992Co-Authors: Howard N. Barrow, Mark J. LevensonAbstract:• Necrotizing "malignant" External Otitis is a life-threatening skull base infection that originates in the External auditory canal and is characterized by otalgia and purulent aural discharge with External auditory canal cellulitis and granulation. Necrotizing External Otitis, seen almost exclusively in elderly diabetics, is almost always caused by Pseudomonas aeruginosa . To our knowledge, there have been only six nonpseudomonal cases reported to date. We describe a 70-year-old diabetic man with necrotizing External Otitis caused by Staphylococcus epidermidis , confirmed by serial cultures. This case was characterized by otalgia, purulent otorrhea, preauricular swelling, bony External auditory canal erosion, and a conductive hearing loss. Despite prolonged intravenous antistaphylococcal antibiotic therapy and frequent local debridement, the patient's symptoms never completely resolved. As demonstrated by the treatment failure, S epidermidis necrotizing External Otitis, may represent a more refractory form of this already virulent disease process. We believe this to be the first reported case of necrotizing External malignant Otitis caused by S epidermidis . ( Arch Otolaryngol Head Neck Surg. 1992;118:94-96)
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Ciprofloxacin: drug of choice in the treatment of malignant External Otitis (MEO).
The Laryngoscope, 1991Co-Authors: Mark J. Levenson, Simon C. Parisier, Jay Dolitsky, Gurpaul BindraAbstract:Ciprofloxacin, a fluorinated quinolone with high efficacy against Pseudomonas aeruginosa, was used in the treatment of 10 consecutive patients with malignant External Otitis. All patients had skull base osteomyelitis documented by nuclear and computed tomography (CT) scans. Dosages of 1.5 g of ciprofloxacin daily were used for a mean average of 10 weeks. All patients were considered cured with a minimum follow-up of 18 months after completion of therapy. A new classification of malignant External Otitis (MEO) is presented.
Nechama Uri - One of the best experts on this subject based on the ideXlab platform.
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semiquantitative skull planar and spect bone scintigraphy in diabetic patients differentiation of necrotizing malignant External Otitis from severe External Otitis
The Journal of Nuclear Medicine, 1994Co-Authors: Ruth Hardoff, Nechama Uri, Sara Gips, Avi Front, Ada TamirAbstract:UNLABELLED Early diagnosis of necrotizing External Otitis (NEO) includes the use of bone scintigraphy since clinical assessment alone cannot differentiate the necrotizing type of Otitis from the severe type of External Otitis in which there is no extension to the adjacent bone. Four-hour planar bone scintigraphy may reflect soft-tissue infection, and therefore may not be useful in distinguishing NEO from severe External Otitis (SEO). Twenty-four-hour bone scintigraphy using planar or SPECT imaging may better reflect bone uptake and increase the accuracy of the test. METHODS Twenty-six diabetic patients (12 diagnosed NEO; 14 SEO) and 10 nondiabetic (ND) patients were studied. Lesion-to-nonlesion (L/N) count ratios obtained from planar and SPECT imaging at 4 hr, 24 hr and 24 hr/4 hr (24/4) were assessed. RESULTS Count ratios obtained from the 4- and 24-hr planar and SPECT images were significantly higher in the NEO patients compared to SEO patients for both planar and SPECT studies (p < 0.001, 0.005). The 24/4 count ratio was also significantly higher in the NEO patients on the planar (p < 0.01) and the SPECT studies (p < 0.001). The ND patients were not different from SEO patients on 4-hr planar, 4- and 24-hr SPECT as well as 24/4-hr planar and SPECT studies. The L/N count ratio threshold yielding the best sensitivity for detecting NEO was 1.05 for the 24/4 SPECT study. CONCLUSION In diabetic patients, an early distinction between NEO and SEO patients can be reliably made by using L/N count ratios on 24/4 or 24-hr SPECT bone scintigraphy.
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Quantitative bone and 67Ga scintigraphy in the differentiation of necrotizing External Otitis from severe External Otitis.
Archives of otolaryngology--head & neck surgery, 1991Co-Authors: Nechama Uri, Sara Gips, Avi Front, Shlomo Walter Meyer, Ruth HardoffAbstract:• Qualitative technetium Tc 99m bone scintigraphy using phosphate compounds and gallium 67 scintigraphy were described as a helpful means in diagnosing necrotizing External Otitis (NEO). They were, however, claimed to be nonspecific. Quantitative Tc 99m methylene diphosphonate bone scintigraphy and gallium 67 scintigraphy were performed in eight patients with NEO and in 20 patients with severe External Otitis, in order to prove usefulness of scintigraphy in the diagnosis of NEO. Ratios of lesion to nonlesion for bone scintigraphy were 1.67 ± 0.16 in patients with NEO and 1.08 ± 0.09 in patients with severe External Otitis, and for gallium 67 scintigraphy they were 1.35 ± 0.24 in NEO patients and 1.05 ± 0.03 in patients with severe External Otitis. There was no difference in uptake between diabetic patients with severe External Otitis and nondiabetic patients. The scintigraphic studies were also evaluated using a qualitative scoring method (scores 0 to +4), according to the intensity of the radiopharmaceutical uptake. This method was found to be inferior in the diagnosis of NEO compared with the quantitative method. We conclude that lesion-to-nonlesion ratios greater than 1.5 and 1.3 on bone and gallium 67 scintigraphy, respectively, are indicative of NEO. Quantitative bone scintigraphy, which is quicker to perform, may be used as a single imaging modality for the diagnosis of NEO. ( Arch Otolaryngol Head Neck Surg . 1991;117:623-626)
Avi Front - One of the best experts on this subject based on the ideXlab platform.
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semiquantitative skull planar and spect bone scintigraphy in diabetic patients differentiation of necrotizing malignant External Otitis from severe External Otitis
The Journal of Nuclear Medicine, 1994Co-Authors: Ruth Hardoff, Nechama Uri, Sara Gips, Avi Front, Ada TamirAbstract:UNLABELLED Early diagnosis of necrotizing External Otitis (NEO) includes the use of bone scintigraphy since clinical assessment alone cannot differentiate the necrotizing type of Otitis from the severe type of External Otitis in which there is no extension to the adjacent bone. Four-hour planar bone scintigraphy may reflect soft-tissue infection, and therefore may not be useful in distinguishing NEO from severe External Otitis (SEO). Twenty-four-hour bone scintigraphy using planar or SPECT imaging may better reflect bone uptake and increase the accuracy of the test. METHODS Twenty-six diabetic patients (12 diagnosed NEO; 14 SEO) and 10 nondiabetic (ND) patients were studied. Lesion-to-nonlesion (L/N) count ratios obtained from planar and SPECT imaging at 4 hr, 24 hr and 24 hr/4 hr (24/4) were assessed. RESULTS Count ratios obtained from the 4- and 24-hr planar and SPECT images were significantly higher in the NEO patients compared to SEO patients for both planar and SPECT studies (p < 0.001, 0.005). The 24/4 count ratio was also significantly higher in the NEO patients on the planar (p < 0.01) and the SPECT studies (p < 0.001). The ND patients were not different from SEO patients on 4-hr planar, 4- and 24-hr SPECT as well as 24/4-hr planar and SPECT studies. The L/N count ratio threshold yielding the best sensitivity for detecting NEO was 1.05 for the 24/4 SPECT study. CONCLUSION In diabetic patients, an early distinction between NEO and SEO patients can be reliably made by using L/N count ratios on 24/4 or 24-hr SPECT bone scintigraphy.
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Quantitative bone and 67Ga scintigraphy in the differentiation of necrotizing External Otitis from severe External Otitis.
Archives of otolaryngology--head & neck surgery, 1991Co-Authors: Nechama Uri, Sara Gips, Avi Front, Shlomo Walter Meyer, Ruth HardoffAbstract:• Qualitative technetium Tc 99m bone scintigraphy using phosphate compounds and gallium 67 scintigraphy were described as a helpful means in diagnosing necrotizing External Otitis (NEO). They were, however, claimed to be nonspecific. Quantitative Tc 99m methylene diphosphonate bone scintigraphy and gallium 67 scintigraphy were performed in eight patients with NEO and in 20 patients with severe External Otitis, in order to prove usefulness of scintigraphy in the diagnosis of NEO. Ratios of lesion to nonlesion for bone scintigraphy were 1.67 ± 0.16 in patients with NEO and 1.08 ± 0.09 in patients with severe External Otitis, and for gallium 67 scintigraphy they were 1.35 ± 0.24 in NEO patients and 1.05 ± 0.03 in patients with severe External Otitis. There was no difference in uptake between diabetic patients with severe External Otitis and nondiabetic patients. The scintigraphic studies were also evaluated using a qualitative scoring method (scores 0 to +4), according to the intensity of the radiopharmaceutical uptake. This method was found to be inferior in the diagnosis of NEO compared with the quantitative method. We conclude that lesion-to-nonlesion ratios greater than 1.5 and 1.3 on bone and gallium 67 scintigraphy, respectively, are indicative of NEO. Quantitative bone scintigraphy, which is quicker to perform, may be used as a single imaging modality for the diagnosis of NEO. ( Arch Otolaryngol Head Neck Surg . 1991;117:623-626)
