Optimised diagnosis and treatment of necrotizing external otitis is warranted

Necrotizing external otitis (NEO) is a devastating and life-threatening infection in the external auditory canal and the temporal bone. The aim of this paper is to evaluate the diagnostics and treatment of NEO and to recommend new guidelines.

Eleven patients were retrospectively enrolled under the code DH609 otitis externa without specification from 1 January 2000 to 31 December 2009. Records were reviewed to register: age, symptoms, clinical findings, comorbidity, imaging, microbiology and treatment.

The median age was 75 years and the median time of therapy at the hospital was 6.3 months. All patients belonged to a risk group. A diagnostic delay was found resulting in further progression of the disease. In contrast to current international recommendations, the treatment consisted mostly of local antibiotics in combination with surgery. All patients survived, but most patients were left with hearing loss and psychiatric problems.

A greater awareness of diagnostic criteria and a shift from local antibiotics to prolonged systemic monotherapy with ciprofloxacin in accordance with international concepts is recommended. Surgery should be left for extensive and refractory cases only. A list of diagnostic criteria and treatment guidelines is presented.

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