Necrotising otitis externa: a serious condition becoming more frequently encountered

Abstract

Background Necrotising otitis externa is an aggressive infection of the external ear, which extends to the surrounding bone and soft tissue. In recent years, there has been an apparent increase in the number of patients admitted to our hospital with this condition. Methods A retrospective review was conducted of all patients admitted to our hospital with necrotising otitis externa between July 2012 and June 2020. Results Among 39 patients included, only 9 were diagnosed in the first four years, and 30 were diagnosed in the last four years. There were 27 males and 12 females, and the mean age was 78.7 years. There were six non-diabetic immunocompetent patients. Cranial nerve palsies developed in 50 per cent of the patients. Disease-related mortality was 7.7 per cent. A favourable outcome was recorded in 66.7 per cent of the patients. Conclusion Necrotising otitis externa is associated with high morbidity and mortality. The incidence of the disease is rising in our local geographical area.

Clinical Spectrum and Treatment Response of Malignant Otitis Externa Patients: A Rural Tertiary Care Centre Experience

“…The facial nerve is often involved. Sigmoid sinus involvement causes retrograde thrombophlebitis [3,7]. Intracranial extension results in the involvement of opposite skull bases [1,7].…”

“…Malignant otitis externa (MOE) is a misnomer since it is not a neoplastic process [1]. It implies an aggressive inflammation of the external auditory canal in elderly diabetic, and immunocompromised individuals with Pseudomonas aeruginosa as the main culprit followed by methicillin-resistant Staphylococcus aureus and other fungal organisms [2,3]. The inflammatory process is so fierce that it may involve the skull base leading to Skull Base Osteomyelitis [3].…”

“…It implies an aggressive inflammation of the external auditory canal in elderly diabetic, and immunocompromised individuals with Pseudomonas aeruginosa as the main culprit followed by methicillin-resistant Staphylococcus aureus and other fungal organisms [2,3]. The inflammatory process is so fierce that it may involve the skull base leading to Skull Base Osteomyelitis [3]. The sequelae of this catastrophic condition can result in facial nerve palsy in adjunction to other lower cranial nerve palsies leading to deterioration in the quality of life [4][5][6][7].…”

Necrotising otitis externa, turbinate surgery, tonsillotomy, and care of octogenarian head and neck cancer patients

“…5 This scoring system uses inherent patient factors rather than the usual disease severity related assessments, so might help raise vigilance in patients who could otherwise be seen as relatively low risk based on disease status alone. Eweiss and colleagues from Essex, UK, 6 found that the incidence of necrotising otitis externa in their geographical area had increased dramatically in recent years, with cases sometimes and surprisingly involving immunocompetent patients.…”

Improving outcomes in necrotising otitis externa, telephone clinics, and topical pimecrolimus for chronic eczematous external otitis

“…Improving outcomes in necrotising otitis externa, telephone clinics, and topical pimecrolimus for chronic eczematous external otitis Jonathan Fishman and Edward Fisher, Editors Necrotising otitis externa is an aggressive infection of the external ear, the incidence of which is increasing. [1][2][3][4] The optimal strategy for the diagnosis and management of necrotising otitis externa remains uncertain, and there is considerable variability in how the condition is managed. 5,6 Several articles in this month's issue of The Journal of Laryngology & Otology address this condition.…”