الفهرس 
Malignant Otitis ExternaOnly 14 pages are availabe for public view
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Abstract
Malignant otitis externa (MOE) is a serious, life threatening infection of the skull base, which originates from soft tissues of the external auditory canal. The causative organism is usually Pseudomonas aeruginosa, and the disease commonly occurring in elderly patients with diabetes and incidents of MOE in children and HIV-positive patients have been reported recently.The infection begins as an external otitis that progress into osteomyelitis of the temporal bone. Spread of the disease outside the external auditory canal occurs through the fissures of Santorini and the Osseo cartilaginous junction (Narozny et al., 2006).The cardinal clinical feature of patients with MOE are variable severity of otalgia, otorrhea, conductive hearing loss, headache, granulation tissue in the external auditory canal and facial palsy (Carfae and Kesser, 2008).As regards the diagnosis, there is no single pathognomonic criterion that defines malignant otitis externa. The diagnosis is based on highly index suspension for MOE, but it is generally made from a clinical, microbiological and radio graphical findings (Rubin and Yu, 1988).First goal of treatment for MOE is the control of diabetis or other predisposing factors at maximal level.Antibiotic is the mainstay for treatment of malignant otitis externa both systematic local ; oral Fluoroquinolones (norfloxacin, lomefloxacin, fleroxacin, ciprofloxacin, enoxacin, trovafloxacin, gatifloxacin, ofloxacin, Levofloxacin) are very effective against P.aeruginosa while third-generation cephalosporins with antipseudomonal activity, such as ceftazidime and ceftriaxone can be used as an alternative or added to ciprofloxacin in the treatment of MOE (Carfrae and Kesser., 2008).Hyperbaric oxygen (HBO) therapy had been used for treatment of MOE as adjuvant and reduced the morbidity and mortality resulting from MOE. Oxygen, at increased pressures, augments tissue oxygen partial pressure, allowing increased bacterial killing by providing substrate for the formation of oxygen free radicals and augmenting respiratory burst (Sheikh et al., 2000).We analyzed 306 patients in 16 articles of MOE (group A) managed by antibiotic alone and 56 patients in 6 articles managed by antibiotic and HBO (group B ) by using meta-analysis of published medical articles and electronic data base concerning management of MOE either by antibiotic alone or HBO as an adjuvant treatment through searching the Conchrane central register of controlled trials, MEDLINE, EMBASE and Pub-med.98% of group A was diabetic and 2% were immunocomprimized patients. Their mean age was 62 years and all patients treated by fluoroquinolones combined with third generation cephalosporins. Treatment continued for 7.8 weeks in average. So that overall improvement rate was 83% On the other hand, group B treated by antibiotic with HBO, 96% patients were diabetic and 4% are immunocomprimized, their mean age was 64 years and all patients were given fluoroquinolones, combined with third generation cephalosporins. Duration of antibiotic was 7.6 weeks in average, and also was combined with HBO in 90 minutes twice daily on breathing of 100% oxygen at a pressure of 2.5 atmospheres absolute (ATA), six times a week, in a walk-in chamber. Patients received course of HBO in 30 sessions in average. The overall improvement rate was 82%.In conclusion, there is no clear evidence exists to show the efficacy of hyperbaric oxygen therapy as adjuvant plus antibiotic when compared to treatment with antibiotics alone except for facial nerve paralysis as there was statistically highly significant difference in improvement rate of it by adding to HBO.In result of lack of randomized controlled study we recommend Randomized controlled study to show the efficacy of adding HBO to antibiotic therapy.