Necrotising otitis externa: A single centre experience

Abstract

Introduction Necrotising otitis externa (NOE) is a rare infection of the ear canal with frequent bone erosion. This study’s objective is to describe the different features of NOE as well as its management in an ear-nose-throat department. We also tried to identify the particularities of the fungal infection. Patients and methods It is an observational cohort that included all the patients hospitalised for the management of NOE. The study was carried out in the ear-nose-throat Department of Mahdia University Hospital in Tunisia between January 2006 and december 2019. Results A total of 40 patients were included. The mean age was 65 ± 12.9 years and the sex ratio was 0.9. Ninety percent of the patients included were diabetics. The most common signs found were oedema of the external canal (97.5%) and auricular discharge (92.5%). The main pathogen isolated was Pseudomonas aeruginosa (61.7%). Fungi were isolated in 9 cases (26.47%). Computed tomography was performed for 32 patients (80%). Bone erosion was seen in 26 cases (81.3%). The main complications were cerebral venous thrombosis, retropharyngeal abscess and cerebral empyema. Thirty one patients received only antibiotics, 2 received only antifungal treatment, and 7 received both antibiotics and antifungal treatment. All patients had a favorable outcome. Univariate analysis showed a higher median erythrocyte sedimentation rate was associated with fungal infections. No other differences were noted. Conclusion Our management protocol seems to be efficient since all patients had initial favorable outcome. A higher median erythrocyte sedimentation rate was associated with fungal infections.

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

“…Several authors acknowledged the lack of universally accepted diagnostic criteria, 4,35 and considered that this may account for apparent differences in incidence. 13 A snapshot survey of clinicians by Chawdhury et al .…”

“…[21][22][23][24][25][26][27][28][29][30][31][32][33] Others based patient inclusion on the diagnosis made by senior authors 34 and the International Classification of Diseases code at discharge. 12 Several authors acknowledged the lack of universally accepted diagnostic criteria, 4,35 and considered that this may account for apparent differences in incidence. 13 A snapshot survey of clinicians by Chawdhury et al 11 ascertained that there is variation in the diagnostic criteria used by clinicians in the UK to diagnose necrotising otitis externa.…”

Necrotising otitis externa: a serious condition becoming more frequently encountered

“…6,12 However, 66.7 per cent of patients in the present study improved or recovered from necrotising otitis externa, which is a lower rate than that reported by others. 5,6 This disparity potentially stems from a loss of patients to follow up: it is possible that the patients with no documented follow up who were thus excluded from outcome analysis had actually experienced improvement.…”

“…4 Untreated necrotising otitis externa may be associated with up to 50 per cent mortality. 5 Even with treatment using appropriate antibiotics, mortality figures as high as 15 per cent have been reported. 4 The disease may also lead to prolonged and recurrent hospital admissions.…”

Predictive value of radiologic studies for malignant otitis externa: a systematic review and meta-analysis

“…It is a rare but life-threatening complication of external otitis that often develops in diabetic and immunocompromised patients. 1 In 1987, Cohen and Friedman described diagnostic criteria for NOE. Major criteria include symptoms and signs of otalgia, otorrhea, edema, granulation tissue, and postoperative micro abscess, as well as imaging findings including a positive bone scan with technetium-99m or gallium-67.…”