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Necrotizing otitis externa: a systematic review.

Pouya Mahdyoun1, Céline Pulcini, Ivan Gahide

  • 1Institut Universitaire de la Face et du Cou, Head and Neck Department-Nice University Hospital, Nice, France.

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology
|April 20, 2013
PubMed
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Necrotizing otitis externa (NOE) management lacks strong evidence, relying on clinical suspicion. This review highlights typical at-risk populations and challenges like delayed treatment and antibiotic resistance.

Area of Science:

  • Otolaryngology
  • Infectious Diseases
  • Evidence-Based Medicine

Background:

  • Necrotizing otitis externa (NOE) is a severe infection of the external ear canal.
  • The condition disproportionately affects elderly, male, and diabetic patients.
  • Current management often relies on empirical clinical judgment due to limited evidence.

Purpose of the Study:

  • To systematically review scientific evidence on necrotizing otitis externa.
  • To emphasize epidemiologic data, diagnostic criteria, treatment, follow-up, prognosis, and evolution.
  • To identify gaps in current knowledge and clinical practice.

Main Methods:

  • Systematic review of PubMed/MEDLINE and Cochrane Database of Systematic Reviews (1968-2011).
  • Inclusion of publications with at least 6 cases; exclusion of non-external ear osteomyelitis.

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  • Assessment of publication quality using international guidelines.

    • Main Results:

    • Absence of strong scientific evidence for diagnosis, treatment, and follow-up criteria.
    • Confirmation of a typical at-risk population (elderly, male, diabetic).
    • Identification of key issues: lack of primary prevention, delayed management, antibiotic misuse leading to resistance, and recurrent cases.

    Conclusions:

    • Clinical practice for NOE is largely empirical due to insufficient evidence.
    • Improved medical information dissemination is crucial for better management of this severe disease.
    • Addressing issues like delayed referral and antibiotic stewardship is essential.