HSC Section 8_April 2017

Loh and Loh

Table 1. Inflammatory marker level comparison between disease progression and disease resolution groups.

Disease Resolved

Disease Progressed

P Value

At diagnosis

TWC, mean, 3 10 9 /L

8.81

12.02 34.00 75.00

.118 .759 .357 .300 .209 .669 .014 .491 .120

CRP, mean, mg/L ESR, mean, mm/h

41.60 58.11

2 weeks after antibiotics TWC, mean, 3 10 9 /L

7.68

9.14

CRP, mean, mg/L ESR, mean, mm/h

13.80 51.20

29.57 58.71

6 weeks after antibiotics TWC, mean, 3 10 9 /L

7.09

10.72 27.00 74.67

CRP, mean, mg/L ESR, mean, mm/h

17.89 49.00

Abbreviations: CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; TWC, total white cell count.

30 40 50 60 70 80 0 10 20

Pan-sensitive 66 7% .

Pseudomonas aeruginosa (n=9) Klebsiella pneumoniae (n=1)

- - - Progressed ___ Resolved

Multi-drug resistant

[mg/L] [x10 9 /L] [mm/hr]

ESR CRP TWC

33.3%

Positive culture (n=12)

Contaminants (n=2)

Diagnosis 6 weeks Figure 1. Inflammatory marker trends during a period of antibiotic treatment in the group in which disease resolved compared with the group in which disease progressed. CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; TWC, total white cell count. 2 weeks

Figure 2. Breakdown of positive ear swab culture results.

in 60% (n = 6), clivus in 50% (n = 5), and dural enhance- ment in 40% (n = 4). A subset of our patients had clival involvement, either as contiguous spread or direct involvement. This subset was noted to have poorer prognosis and required lengthier anti- biotic therapy. Five patients had clival involvement on CT or MRI. All patients with clival involvement had disease that persisted after 6 weeks of antibiotics compared with 14.3% (n = 2) in those without ( P = .002). Clival involve- ment was also strongly associated with mortality and was seen in 75% (n = 3) of mortalities. Microbiology and Antibiotic Therapy Ear swabs were routinely performed. Organisms were identi- fied in only 63.2% (n = 12). The results of those with posi- tive cultures are represented in Figure 2 . Pseudomonas aeruginosa was the main organism and was present in 75.0% (n = 9). Multidrug-resistant Pseudomonas contributed to 33.3% (n = 3) of P aeruginosa isolates. Two patients with positive cultures had light growth of Staphylococcus epider- midis that were deemed as contaminants. There was no par- ticular organism that occurred more often in the 3 patients

Table 2. Frequency of minor and major CT scan findings.

No. (%)

Minor findings

EAC tissue swelling EAC bony erosion Mastoid involvement

16 (94.1) 15 (88.2) 16 (94.1) 4 (23.5) 4 (23.5) 3 (17.6) 1 (5.9)

Major findings

Infratemporal fossa

Temporomandibular joint Parapharyngeal involvement Nasopharyngeal involvement

Abbreviation: EAC, external auditory canal.

Magnetic resonance imaging (MRI) was used in 52.6% (n = 10) to delineate soft tissue involvement or intracranial extension. Common areas of involvement were the masti- cator space in 50% (n = 5), condylar bone marrow in 30% (n = 3), parapharyngeal space in 40% (n = 4), nasopharynx

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