Management of Necrotizing Otitis Externa: Our Experience with Forty-Three Patients

Abstract

OBJECTIVE:To assess the impact of the introduction of a dedicated management protocol of necrotizing otitis externa patients with joint care between otorhinolaryngology and infectious diseases. MATERIALS and METHODS:Retrospective review of case notes and the otorhinolaryngology department database of all adults admitted with necrotizing otitis externa at our teaching hospital over a 5-year period. The patients were split into two groups (first group of 10 patients prior to the introduction of the dedicated management protocol, and a second group of 33 patients managed after the introduction of this protocol). RESULTS:Of the 43 patients included in the study, diabetes mellitus was present in 83.7%. Pseudomonas aeruginosa was grown in 67.4% of patients. All 43 patients underwent computed tomography and magnetic resonance imaging (with contrast) scans. Surgical intervention was undertaken in 25.6% of patients. Mean follow-up was 10 months (SD, ±7 months). Of the 43 patients, 79.1% made a full recovery and were discharged. Relapse occurred in 9.3% of patients. One patient died because of a myocardial infarction 4 months after treatment. The mean length of stay was significantly lower after the protocol was introduced (25.6±5.3 vs. 14.2±3.8 days, p=0.001), and the duration of treatment was also significantly lower after the protocol (21.2±6.8 vs. 14.3±4.3 weeks, p=0.01). CONCLUSION:The introduction of a dedicated management protocol and joint care with otorhinolaryngology and infectious diseases resulted in improved care and decreased length of stay in patients. Early diagnosis and involvement with the relevant teams as well as prompt intervention are the key factors that reduce morbidity and mortality.

A review of thirty‐nine patients diagnosed with necrotising otitis externa over three years: Is CT imaging for diagnosis sufficient?

“…In general, mortality rates have been improving with Kwon et al initially describing a rate of 50% in 14 patients over a 6‐year period, followed by Chen et al describing a mortality rate of 19.2% in 26 patients over a 12‐year period . More recently, Sharma et al described a mortality rate of 2.3% in 43 patients over a 5‐year period . The mortality rate in our 2016/2017 group of patients was 3.7%.…”

“…Our study involved a larger number of patients than most of the case series published previously, other than the recently published paper by Sharma et al 5 who looked at 43 patients over a 5-year period. [5][6][7] We also looked at the false-negative rates of CT scans in radiological diagnoses for NOE (in patients with positive MRIs), which has not been published previously.…”

Emerging themes in necrotising otitis externa: a scoping review of the literature from 2011 to 2020 and recommendations for future research

“…Specimens were obtained from a swab of the ear canal alone in 15 studies, from both a swab and tissue biopsy in 10 studies, and from tissue biopsies alone in 2 studies; in another 5 studies, microbiological sampling was carried out, but the technique was not specified. 40–55…”

“…10,16,39 Microbiological sampling and culture Specimens were obtained from a swab of the ear canal alone in 15 studies, from both a swab and tissue biopsy in 10 studies, and from tissue biopsies alone in 2 studies; in another 5 studies, microbiological sampling was carried out, but the technique was not specified. [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] Pseudomonas aeruginosa remains the most common pathogen isolated (mean of 64.7 per cent of cultures across the case series; range, 25-100 per cent). Pseudomonal resistance appears to be consistent at 27 per cent when compared to 33 per cent reported by Mahdyoun et al 3 Pseudomonal resistance has been attributed to overzealous use of fluoroquinolones and delays in diagnosis allowing the organisation of biofilms.…”

Value of Mastoidectomy in Malignant Otitis External

“…In our study, surgically treated patients are about 42% of all MOE (3276/). Sharma et al mentioned that surgical intervention is about 25% in MOE [6] . According to Gruber et al, 4 of 5 patients with resistant inflammation need surgery [7] .…”