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. 2022 Jul;136(7):604-610.
doi: 10.1017/S002221512100462X. Epub 2022 Jan 19.

Characteristics, management and outcome of a large necrotising otitis externa case series: need for standardised case definition

S H Hodgson  1   2 , V J Sinclair  3 , J Arwyn-Jones  3   4 , K Oh  3 , K Nucken  1   3 , M Perenyei  3 , V Sivapathasingam  3   5 , P Martinez-Devesa  3 , S T Pendlebury  6   7 , J D Ramsden  3 , P C Matthews  1   8 , P Pretorius  9 , M I Andersson  1   10
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Characteristics, management and outcome of a large necrotising otitis externa case series: need for standardised case definition

S H Hodgson et al. J Laryngol Otol. 2022 Jul.

Abstract

Background: Necrotising otitis externa is a severe ear infection for which there are no established diagnostic or treatment guidelines.

Method: This study described clinical characteristics, management and outcomes for patients managed as necrotising otitis externa cases at a UK tertiary referral centre.

Results: A total of 58 (63 per cent) patients were classified as definite necrotising otitis externa cases, 31 (34 per cent) as probable cases and 3 (3 per cent) as possible cases. Median duration of intravenous and oral antimicrobial therapy was 6.0 weeks (0.49-44.9 weeks). Six per cent of patients relapsed a median of 16.4 weeks (interquartile range, 23-121) after stopping antimicrobials. Twenty-eight per cent of cases had complex disease. These patients were older (p = 0.042), had a longer duration of symptoms prior to imaging (p < 0.0001) and higher C-reactive protein at diagnosis (p = 0.005). Despite longer courses of intravenous antimicrobials (23 vs 14 days; p = 0.032), complex cases were more likely to relapse (p = 0.016).

Conclusion: A standardised case-definition of necrotising otitis externa is needed to optimise diagnosis, management and research.

Keywords: Antimicrobial; Externa; Malignant; Necrotising; Otitis; Pseudomonas.

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Figures

Fig. 1.
Fig. 1.
Consort diagram of patients meeting eligibility criteria for inclusion in the study. NOE = necrotising otitis externa
Fig. 2.
Fig. 2.
Numbers of new cases presenting each year (August to July).
See this image and copyright information in PMC

References

    1. Rubin Grandis J, Branstetter BF, Yu VL. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis 2004;4:34–9 - PubMed
    1. Sylvester MJ, Sanghvi S, Patel VM, Eloy JA, Ying YM. Malignant otitis externa hospitalizations: analysis of patient characteristics. Laryngoscope 2017;127:2328–36 - PubMed
    1. Stern Shavit S, Soudry E, Hamzany Y, Nageris B. Malignant external otitis: factors predicting patient outcomes. Am J Otolaryngol 2016;37:425–30 - PubMed
    1. Chawdhary G, Liow N, Democratis J, Whiteside O. Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistics trends. J Laryngol Otol 2015;129:600–3 - PubMed
    1. Hopkins ME, Bennett A, Henderson N, MacSween KF, Baring D, Sutherland R. A retrospective review and multi-specialty, evidence-based guideline for the management of necrotising otitis externa. J Laryngol Otol 2020;134:487–92 - PubMed

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