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Eyes, Ears, Nose, and Throat (7%)

Most common causative organism of malignant otitis externa is the Pseudomonas\r\n species.

It has a rapid clinical course in diabetics that can be fatal \r\nif left untreated. Therapy involves the use of high doses of \r\nanti-pseudomonal drugs, such as Ceftazidime. Anti-pseudomonal \r\npenicillins, such as Piperacillin and Ticarcillin, are other very \r\neffective options. In earlier years, quinolones were used widely, but \r\ntheir routine use for upper respiratory infections has increased rates \r\nof Pseudomonal resistance.

Esophagus

\r\n
• Esophagitis
\r\n
• Motility disorders
\r\n
• Mallory-Weiss tear
\r\n
• Neoplasms
\r\n
• Strictures
\r\n
• Varices
\r\n

Stomach

\r\n
• Gastroesophageal reflux disease
\r\n
• Gastritis
\r\n
• Neoplasms
\r\n
• Peptic ulcer disease
\r\n
• Pyloric stenosis
\r\n

Gallbladder

\r\n
• Acute/chronic cholecystitis
\r\n
• Cholangitis
\r\n
• Cholelithiasis
\r\n

Liver

\r\n
• Acute/chronic hepatitis
\r\n
• Cirrhosis
\r\n
• Neoplasms
\r\n

Pancreas

\r\n
• Acute/chronic pancreatitis
\r\n
• Neoplasms
\r\n

Small Intestine/Colon

\r\n
• Appendicitis
\r\n
• Celiac disease
\r\n
• Constipation
\r\n
• Diverticular disease
\r\n
• Inflammatory bowel disease
\r\n
• Intussusception
\r\n
• Irritable bowel syndrome
\r\n
• Ischemic bowel disease
\r\n
• Lactose intolerance
\r\n
• Neoplasms
\r\n
• Obstruction
\r\n
• Polyps
\r\n
• Toxic megacolon
\r\n

Rectum

\r\n
• Anal fissure
\r\n
• Abscess/fistula
\r\n
• Fecal impaction
\r\n
• Hemorrhoids
\r\n
• Neoplasms
\r\n

Hernia

Infectious and Noninfectious Diarrhea

Vitamin and Nutritional Deficiencies

Metabolic Disorders

\r\n
• Phenylketonuria
\r\n
\r\n

Both the American Academy of Pediatrics and the American Academy of Family Physicians define 3 criteria that must be present in order to make the diagnosis of AOM:

• acute onset of symptoms
• the presence of fluid in the middle ear (evidenced by the presence of a fluid line or visibility of purulent fluid)
• signs and symptoms of middle-ear inflammation (e.g., erythema, bulging, decreased mobility via pneumatic insufflation)

The clinical presentation is most consistent with Ménière's disease, \r\nwhich is thought to be caused by excess endolymph in the labyrinth. This\r\n condition causes no MRI abnormalities. The incidence of Ménière's disease ranges from 10-150 cases per 100,000 people each year.

Acoustic neuromas may cause similar symptoms, but facial numbness is \r\nalso usually present. In addition, vertigo is less commonly reported, as\r\n the symptom onset is more gradual. Acoustic neuromas are also fairly \r\nrare, occurring about 10 times per 1 million people each year.