HSC Section 8_April 2017

Madani G, Connor SE. Imaging in pulsatile tinnitus. Clin Radiol . 2009; 64(3):319-328. EBM level 5......................................................................................................................................69-78

Summary : This article is a review series of radiologic evaluation of pulsatile tinnitus. The authors review previous articles describing anatomical abnormalities including tumors and percentages seen in previous studies. Included is an evaluation tree describing the workup of pulsatile tinnitus and images of anatomical abnormalities.

Weinreich H, Carey JP. Prevalence of pulsatile tinnitus among patients with migraine. Otol Neurotol . 2016; 37(3):244-247. EBM level 4.......................................................................79-82

Summary : This is a retrospective evaluation of patients with diagnosis codes of both migraine and pulsatile tinnitus. Of the 145 patients evaluated with both diagnoses, patients with objective tinnitus were excluded from evaluation, leaving 16 patients for evaluation. Patients were prescribed a migraine diet +/- migraine prophylaxis. Patients were then evaluated for improvement in tinnitus and headaches. The majority of patients received improvement with the diet whereas the medication made little difference, but this may be due to the fact that these patients were more severe cases. The study highlights the importance of treatment modalities, but doesn’t describe complications. Hobson CE, Moy JD, Byers KE, et al. Malignant otitis externa: evolving pathogens and implications for diagnosis and treatment. Otolaryngol Head Neck Surg . 2014; 15(1):112-116. EBM level 4............................................................................................................................83-87 Summary : This is a retrospective chart review of 20 patients with malignant otitis externa (MOE) treated at a tertiary care institution between 1995 and 2012. Forty-five percent of patients had culture-positive Pseudomonas aeruginosa , and 15% grew methicillin-resistant Staphylococcus aureus (MRSA). Signs and symptoms were similar across groups. However, all P. aeruginosa patients had diabetes, but only 33% of MRSA patients were diabetic. Patients with MRSA required on average 4.7 more weeks of therapy with antibiotics versus non-MRSA patients. The study highlights the evolving pathogens in MOE even in nondiabetic patients. Loh S, Loh WS. Malignant otitis externa: an Asian perspective on treatment outcomes and prognostic factors. Otolaryngol Head Neck Surg . 2013; 148(6):991-996. EBM level 3......................................................................................................................................88-93 review from 2006 to 2011 on 19 MOE patients who received 6 weeks of intravenous ceftazidime combined with oral fluoroquinolone. They did not discuss concurrent topical therapy. Disease resolved in 63% of patients, and mortality was 21%. Age, diabetic control, time delay in diagnosis, cranial nerve involvement, and inflammatory markers were not predictors of prognosis. Erythrocyte sedimentation rate and C reactive protein levels correlated with disease activity and were used to monitor progress. Clivus involvement implied persistent disease. Sixty-three percent of cultures were positive, usually Pseudomonas aeruginosa , and 33% of isolates were multi-drug resistant. Culture-directed therapy did not affect outcome. Summary : This is a review article on malignant otitis externa (MOE) treatment, outcome, and prognostic factors from an Asian perspective. The authors performed a retrospective chart

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External Auditory Canal and Middle Ear A. Acute otitis externa