Dados do Trabalho

Título

Hear me out: Emergency imaging patterns in necrotizing otitis externa - early detection

Introdução e objetivo(s)

Necrotizing Otitis Externa (NOE) is a rare and severe infection of the external auditory canal (EAC), skull base, and surrounding structures, primarily affecting elderly diabetic patients. With mortality rates of up to 15%, NOE is predominantly caused by Pseudomonas aeruginosa and can lead to serious complications such as cranial neuropathies, brain abscesses, and osteomyelitis. Early detection and accurate imaging are crucial for effective management. The objective of this study is to review the clinical, anatomical, and imaging features of NOE, emphasizing the importance of early diagnosis through advanced imaging techniques. Additionally, it provides a diagnostic algorithm to differentiate NOE from other similar conditions and highlights the role of imaging in monitoring treatment response.

Método(s)

This study synthesizes findings from clinical cases and imaging studies, including CT and MRI, to illustrate the progression and dissemination of NOE. Key imaging findings are discussed, and a diagnostic algorithm is proposed to guide radiologists in identifying NOE based on bone and soft tissue window findings.

Discussão

NOE typically presents with clinical features that can be difficult to differentiate from other external ear conditions. Imaging reveals bone erosion, particularly in the temporal bone, skull base, and condylar process, as well as soft tissue infiltration in spaces such as the parapharyngeal and masticator spaces. MRI, especially Diffusion Weighted Imaging (DWI), is superior for evaluating soft tissue involvement and monitoring treatment response. Differential diagnoses, including squamous cell carcinoma, cholesteatoma, and Aspergillus otitis, are also discussed, with imaging features that help distinguish these conditions from NOE.

Conclusões

NOE is a life-threatening condition requiring prompt diagnosis and treatment. Radiologists must be familiar with the anatomy of the EAC and surrounding structures to accurately identify and monitor NOE. CT is the initial imaging modality of choice, and advanced imaging techniques, particularly MRI with DWI, play a critical role in both diagnosis and treatment evaluation. Early recognition and appropriate imaging can significantly improve patient outcomes.

Palavras Chave

otitis; infection; Pseudomonas aeruginosa

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