Although malignant (necrotising) otitis externa is not a common diagnosis, there have been a number of recently reported cases with pathogens other than Pseudomonas aeruginosa as the causative organism. In addition, there are many published reports of resistance to antibiotics in cases of malignant otitis externa caused by Pseudomonas aeruginosa. This review aims to assess the cases reported and to clarify the current opinion on the diagnostic criteria and management of such cases.

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Abbreviations: ABPI, ankle-brachial pressure index; CVA, cerebrovascular accident; NDS, neuropathy disability score; VPT, vibration perception threshold.A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Efficacy of Injected Liquid Silicone in the Diabetic Foot to Reduce Risk Factors for UlcerationA randomized double-blind placebo-controlled trialOBJECTIVE -To investigate the effectiveness of injecting liquid silicone in the diabetic foot to reduce risk factors for ulceration in a randomized double-blind placebo-controlled trial. RESEARCH DESIGN AND METHODS-A total of 28 diabetic neuropathic patients without peripheral vascular disease were randomized to active treatment with 6 injections of 0.2 ml liquid silicone in the plantar surface of the foot or to treatment with an equal volume of saline (placebo). No significant differences were evident regarding age or neuropathy status between the 2 groups. All injections were under the metatarsal heads at sites of calluses or high pressures. Barefoot plantar pressures (pedobarography) and plantar tissue thickness under the metatarsal heads (Planscan ultrasound device) were measured at baseline and at 3, 6, and 12 months after the first injection. Injection sites were photographed at all stages, and callus formation was scored as a change from baseline. Throughout the study, patients were treated by the same podiatrist for all podiatry treatment.RESULTS -Patients who received silicone treatment had significantly increased plantar tissue thickness at injection sites compared with the placebo group (1.8 vs. 0.1 mm) (P Ͻ 0.0001) and correspondingly significantly decreased plantar pressures (Ϫ232 vs. Ϫ25 kPa) (P Ͻ 0.05) at 3 months, with similar results at 6 and 12 months. A trend was noted toward a reduction of callus formation in the silicone-treated group compared with no change in the placebo group. E m e r g i n g T r e a t m e n t s a n d T e c h n o l o g i e s CONCLUSIONS

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