Systematic review of the diagnosis and management of necrotising otitis externa: Highlighting the need for high-quality research

Junko Takata^{1

2}, Michael Hopkins³, Victoria Alexander⁴, Oliver Bannister^{5

6}, Lucy Dalton⁷, Laura Harrison⁸, Emily Groves^{9

10}, Hala Kanona¹¹, Gwennan Llwyd Jones¹², Hassan Mohammed¹³, Monique I Andersson^{5

14}, Susanne H Hodgson^{5

15

16}

Affiliations

¹ Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
² Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
³ Department of Ear, Nose and Throat Surgery, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK.
⁴ Department of Ear, Nose and Throat Surgery, St George's University Hospital NHS Trust, London, UK.
⁵ Department of Infection, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁶ Modernising Medical Microbiology, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
⁷ Department of Ear, Nose and Throat Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
⁸ Department of Ear, Nose and Throat Surgery, Royal Berkshire Hospital, Reading, UK.
⁹ Department of General Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
¹⁰ Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
¹¹ Department of Ear, Nose and Throat Surgery, The Royal National Ear Nose and Throat and Eastman Dental Hospital, University College London Hospitals NHS Trust, London, UK.
¹² Public Health Wales, Microbiology, Cardiff, UK.
¹³ Department of Ear, Nose and Throat, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK.
¹⁴ Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
¹⁵ Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
¹⁶ Department of Biochemistry, University of Oxford, Oxford, UK.

PMID: 36759416
DOI: 10.1111/coa.14041

Systematic review of the diagnosis and management of necrotising otitis externa: Highlighting the need for high-quality research

Junko Takata et al. Clin Otolaryngol. 2023 May.

. 2023 May;48(3):381-394.

doi: 10.1111/coa.14041. Epub 2023 Feb 22.

Authors

Affiliations

¹ Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
² Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
³ Department of Ear, Nose and Throat Surgery, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK.
⁴ Department of Ear, Nose and Throat Surgery, St George's University Hospital NHS Trust, London, UK.
⁵ Department of Infection, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁶ Modernising Medical Microbiology, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
⁷ Department of Ear, Nose and Throat Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
⁸ Department of Ear, Nose and Throat Surgery, Royal Berkshire Hospital, Reading, UK.
⁹ Department of General Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
¹⁰ Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
¹¹ Department of Ear, Nose and Throat Surgery, The Royal National Ear Nose and Throat and Eastman Dental Hospital, University College London Hospitals NHS Trust, London, UK.
¹² Public Health Wales, Microbiology, Cardiff, UK.
¹³ Department of Ear, Nose and Throat, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK.
¹⁴ Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
¹⁵ Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
¹⁶ Department of Biochemistry, University of Oxford, Oxford, UK.

PMID: 36759416
DOI: 10.1111/coa.14041

Abstract

Objectives: To present a systematic review and critical analysis of clinical studies for necrotising otitis externa (NOE), with the aim of informing best practice for diagnosis and management.

Design: Medline, Embase, Cochrane Library and Web of Science were searched from database inception until 30 April 2021 for all clinical articles on NOE. The review was registered on PROSPERO (ID: CRD42020128957) and conducted in accordance with PRISMA guidelines.

Results: Seventy articles, including 2274 patients were included in the final synthesis. Seventy-three percent were retrospective case series; the remainder were of low methodological quality. Case definitions varied widely. Median patient age was 69.2 years; 68% were male, 84% had diabetes and 10% had no reported immunosuppressive risk factor. Otalgia was almost universal (96%), with granulation (69%) and oedema (76%) the commonest signs reported. Pseudomonas aeruginosa was isolated in 62%, but a range of bacterial and fungal pathogens were reported and 14% grew no organism. Optimal imaging modality for diagnosis or follow-up was unclear. Median antimicrobial therapy duration was 7.2 weeks, with no definitive evidence for optimal regimens. Twenty-one percent had surgery with widely variable timing, indication, or procedure. One-year disease-specific mortality was 2%; treatment failure and relapse rates were 22% and 7%, respectively.

Conclusion: There is a lack of robust, high-quality data to support best practice for diagnosis and management for this neglected condition. A minimum set of reporting requirements is proposed for future studies. A consensus case definition is urgently needed to facilitate high-quality research.

Keywords: Pseudomonas aeruginosa; malignant otitis externa; necrotising otitis externa; skull base osteomyelitis.

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References

REFERENCES

1. Grandis JR, Branstetter BF, IV, Yu VL. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis. 2004;4(1):34-9.
1. Toulmouche M. Observations on cerebral otorrhea: latest considerations. Gaz Med Paris. 1838;6:422-6.
1. Chandler JR. Malignant external otitis. Laryngoscope. 1968;78(8):1257-94.
1. Kraus DH, Rehm SJ, Kinney SE. The evolving treatment of necrotizing external otitis. Laryngoscope. 1988;98(9):934-9.
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(6):487-92.

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Systematic review of the diagnosis and management of necrotising otitis externa: Highlighting the need for high-quality research

Affiliations

Systematic review of the diagnosis and management of necrotising otitis externa: Highlighting the need for high-quality research

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous