Necrotizing Otitis Externa

Abstract

Our review revealed the absence of strong scientific evidence regarding diagnosis criteria, treatment protocols and follow-up criteria. This implies the use of highly empirical indexes of suspicion in clinical practice. Our review confirmed the existence of a typical but not exclusive population at risk (aged, male, and diabetic patient) and also revealed major issues: lack of primary prevention in population at risk, delays before referral and management, bacteriologic issues caused by antibiotic misuse (agent identification problems, rise of resistant strains), persistence of recurrent cases. A better diffusion of medical information should help improve the management of this severe disease.

Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistics trends

“…6 All our cases were successfully treated using systemic antibiotics. 6 All our cases were successfully treated using systemic antibiotics.…”

“…6 Samples from all five patients grew Pseudomonas aeruginosa. This is in keeping with the published literature on known risk factors.…”

“…6 This reflects the difficulty in diagnosis. For instance, diagnosis was delayed in several patients who developed adverse sequelae before repeat imaging confirmed necrotising (malignant) otitis externa.…”

“…In our own series, only one patient had clear radiological evidence of bony erosion at presentation. 6 If nuclear imaging is unavailable, such patients need close follow up and a low threshold for aggressive antibiotic treatment. Of these four patients, two developed facial palsy in the subsequent weeks, prompting repeat scans which showed osteomyelitis.…”

Necrotizing Otitis Externa: A Disease Barely Known to Neurosurgeons

“…The progression to SBO with the involvement of the temporal, occipital, and other bones, although rare, results in great morbidity and mortality. 4 Skull base osteomyelitis can also be triggered by odontogenic or paranasal sinuses involvement, but less frequently when compared with SBO secondary to NOE. 5…”