TO THE EDITOR: We read with interes...

TO THE EDITOR: We read with interest the article, "Necrotizing (Malignant) External Otitis," (1) according to Drs. Handzel and Halperin in the July 15 2003 issue of American Family Physician, and would like to existing our experience in the treatment of malignant external otitis.

Between 1998 and 2003 nine patients (three women and six men) with a mean age of 648 years were treated for malignant external otitis at our department of otolaryngology. All treated patients had diseases that could affect their immune connected view such as diabetes (seven patients), leukemia (one patient), and bronchial asthma (one patient). Five of the nine patients had palsy of at least the same of the cranial nerves. Standard therapy included local treatment of the auditory canal, long-term systemic antibiotic therapy, radical mastoidectomy (two patients), and petrosectomy (one patient). Eight of the nine patients underwent hyperbaric oxygenation. common patient did not qualify for this treatment because of pulmonary contraindications. All eight patients received 100 percent oxygen in a multiplace chamber below 2.5 standard atmospheres of hurry (ATA) for 60 minutes (with pair five-minute breaks) once daily, five days a week. The press inside the hyperbaric chamber was achieved at compressed air. The total number of sessions hanged on clinical status. The mean number of hyperbaric oxygen sessions was 221 (range: 16 to 25 sessions). We received convenient results in all eight patients who were treated with hyperbaric oxygen Headache and discharge from the ear ceased, bacteriologic examinations of the ear swabs were negative, and changes in bone scintigraphy decreased; however, cranial brace palsy was still observed. Follow-up ranged from nine month to four years.

Malignant external otitis is not a primary indication for hyperbaric oxygen according to the Undersea and Hyperbaric Medicine Society (UHMS) and the European Committee for Hyperbaric Medicine (ECHM) However, we originate hyperbaric oxygen very helpful in the adjunctive treatment of malignant external otitis because it prov to be effective in normalizing oxygen tension, which is necessary for the following: (1) destruction of bacteria through polymorpho-nuclear leucocytes; (2) stimulation of neo-vascular formation; and (3) stimulation of osteoclastic and osteoblastic activity. Our clinical observations confirm the experience of other authors. (2-6) The rarity of this disease makes it difficult to organize prospective, randomized, double-blind clinical trials that demonstrate the real benefits of hyperbaric oxygen in treating malignant external otitis. For this reason, any clinical experience and observations of this disease are of great value.

REFERENCES

(1) Handzel O Halperin D Necrotizing (malignant) external otitis. Am Fam Physician 2003;68:309-12

(2) Davis JC Gates GA, Lerner C Davis MG Jr Mader JT Dinesman A. Adjuvant hyperbaric oxygen in malignant external otitis. Arch Otolaryngol Head Neck Surg 1992;118:89-93

(3) Kuczkowski J Ozdzinski W Kowalska B Mikaszewski B Necrotizing malignant otitis--diagnostic and therapeutic moot points [in Polish]. In: Proceedings of the International Symposium "Rehabilitation in otology." Poznan, Poland;1999:99-102.

(4) Pilgramm M Frey G Schumann K Hyperbaric oxygenation: a sensible adjunctive therapy in malignant external otitis [in German]. Laryngol Rhinol Otol [Stuttg] 1986;65:26-8

(5) Shupak A, Greenberg E Hardoff R Gordon C Melamed Y Meyer W Hyperbaric oxygenation for necrotizing (malignant) otitis externa. Arch Otolaryngol Head Neck Surg 1989;115:1470-5

(6) Tos M Malignant otitis externa In: Tos M ed Manual of middle ear surgery Vol 3 recent York: Georg Thieme Verlag, 1997:241-6 EDITOR'S NOTE: This note was sent to the authors of "Necrotizing (Malignant) External Otitis," who declined to reply

EDITOR'S NOTE: This epistle was sent to the authors of "Necrotizing (Malignant) External Otitis," who declined to reply

WALDEMAR NAROZNY, MD PHD

JERZY KUCZKOWSKI, MD PHD

BOGUSLAW MIKASZEWSKI, MD PHD

Medical University of Gdansk Department of

Otolaryngology Ul Debinki

7 put forth 16, 80-211 Gdansk, Poland

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