Necrotising otitis externa – is a poor outcome predictable? The application of a diagnosis-based scoring system in patients with skull base osteomyelitis

Abstract

Background The increased incidence of necrotising otitis externa over the last decade has had a significant burden on healthcare providers. Several factors may affect outcome, and stratifying risk may allow personalised treatment. Method Retrospectively identified patients were prospectively surveyed over 12 months. The Cox proportional hazards model was used to identify predictors of poor prognosis. Results Twenty-six patients with necrotising otitis externa (average age of 80 years) were admitted from 2018 to 2019. At one year, 19 per cent mortality was observed. A high Charlson Comorbidity Index was associated with increased mortality (p = 0.03), prolonged in-patient stay (p = 0.047) and increased odds of adverse outcomes (odds ratio = 1.48, 95 per cent confidence interval = 0.26–2.67, p = 0.019). The Charlson Comorbidity Index in our prognostic model was validated using the receiver operating characteristic curve (area under the curve = 0.76). Charlson Comorbidity Index score of 5 or more independently predicted one-year morbidity and mortality (hazard ratio = 1.30, 95 per cent confidence interval = 0.94–1.79, p = 0.03). Conclusion Risk-stratifying patients may enable clinicians to holistically counsel patients and tailor their treatment to improve their prognosis and subsequently alleviate the burden of necrotising otitis externa.

Treatment of Skull Base Diseases: A Multidisciplinary Challenge

“…Osteomyelitis represents a rare but severe condition that is potentially associated with life-threatening complications [ 25 ]. The gateway for infection is often related to direct communication with the sinonasal district or the mastoid–middle ear complex but may also derive from the evolution of a necrotizing external otitis [ 26 ]. The management of osteomyelitis requires the long-term, intravenous administration of antibiotics, usually prescribed in collaboration with an infectious disease specialist, along with surgical debridement [ 25 ].…”

Necrotising otitis externa, epistaxis education and aerosol generation in coughing

“…Necrotising otitis externa, epistaxis education and aerosol generation in coughing Edward W Fisher and Jonathan Fishman, Editors Necrotising otitis externa (previously 'malignant otitis externa') has been the topic of several articles in The Journal of Laryngology & Otology in recent years, [1][2][3] and in other ENT journals, 4 as incidence seems to be increasing for a variety of reasons. Patients are usually older adults, diabetic or may have other reasons for immunosuppression, with severe 'deep' ear pain being a key feature and diagnostic delay all too common.…”

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

“…Necrotising (‘malignant’) otitis externa has been the topic of many articles published in The Journal of Laryngology & Otology , with recent years seeing more publications as the incidence of necrotising otitis externa increases. 1–3 An article in this month's issue from Leicester, UK, 4 looks retrospectively at prognosis and the application of a scoring system to help predict outcomes. In one year of study, 26 patients were seen, with a 19 per cent mortality at one year.…”