Publication:

A study on correlation between clinical prognostic markers glycated hemoglobin, erythrocyte sedimentation rate and C-reactive protein levels and the stage of disease in malignant otitis externa

Background Objectives of the study were to establish a clinical correlation between the stages of MOE and biochemical markers namely glycated Hb (HbA1c), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels, to identify improvement in clinical symptomology in MOE following treatment and to correlate with the duration of diabetes mellitus with treatment outcome.

Methods Patients with diabetes mellitus, otalgia and ear discharge presenting to ENT OPD were subjected to detailed history and clinical examination. Otoscopic examination was done. Pus from the EAC was taken for culture and sensitivity. Baseline glycated Hb, ESR and CRP levels and HRCT temporal bone in axial and coronal planes was done. According to clinical findings and CT findings the patients were staged using chandlers staging. Patients were followed up after 1st and 2nd month and otoscopic examination with blood tests was repeated and staged accordinglyResults: Fall in the levels of glycated HbA1c serves as a good prognostic indicator of the disease. Duration of diabetes has no significant impact on the disease prognosis. Most common etiologic agent is Pseudomonas aeruginosa. In spite of improvement in clinical features and inflammatory parameters there was no improvement in clinical staging with treatment. There was a significant fall in ESR and CRP values after treatment for 2 months with antibiotics and analgesics.

Conclusions The study highlights the need to control infection with medical line of treatment which can be monitored by ESR, CRP and glycated HbA1c and that the role for surgical management is limited for stage 1, 2 and 3.