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Necrotizing otitis externa: diagnosis, treatment, and outcome in a case series
Eran Glikson1, Doron Sagiv1, Michael Wolf2
1Department of Otolaryngology, Head and Neck Surgery, The Sheba Medical Center, Tel-Hashomer, Israel.
Abstract:
We reviewed 25 cases of patients diagnosed with necrotizing otitis externa in our tertiary university-affiliated medical center between 2009 and 2015. Mean overall hospitalization duration was 14.52days, 95% of the patients showed specific seasonal incidence. Mean duration of symptoms prior to hospitalization was 6weeks and the duration correlated with outcome. Only 8% of the patients presented with cranial neuropathies; however, this presentation correlated with adverse outcome. Pseudomonas aeruginosa was the main causative organism (50%), with a 30% multidrug-resistance rate. A high rate (35%) of fungal pathogens was noted. Seventeen patients (68%) were eventually operated; however, only 5 patients needed extensive surgery under general anesthesia. Computed tomography (CT) evidence of adjacent structures' involvement correlated with adverse outcome. Eighty percent of our patients improved clinically. The overall death rate was 12% and the disease-related mortality rate was 8%. Our findings state the importance of limited surgical intervention and microbiologic cultures in disease treatment. This is particularly important in patients with cranial neuropathies and CT finding of adjacent structural involvement that correlate with adverse prognosis. A rising pseudomonal antibiotic resistance and fungal infections may challenge antibiotic treatment in the future.
Insights
Necrotizing otitis externa (NOE) treatment requires careful consideration of limited surgery and cultures. Cranial neuropathies and CT findings indicate poor prognosis, while rising antibiotic resistance poses future challenges.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Medical Microbiology
Background:
- Necrotizing otitis externa (NOE) is a severe infection of the external auditory canal.
- It primarily affects elderly patients with diabetes and can lead to significant morbidity.
Purpose of the Study:
- To analyze clinical characteristics, treatment outcomes, and prognostic factors in patients with necrotizing otitis externa.
- To highlight the role of surgical intervention, microbial patterns, and imaging in managing NOE.
Main Methods:
- Retrospective review of 25 necrotizing otitis externa cases from 2009-2015.
- Analysis of clinical presentation, duration of symptoms, causative organisms, treatment strategies, and outcomes.
- Correlation of computed tomography (CT) findings and cranial neuropathies with patient prognosis.
Main Results:
- Mean hospitalization was 14.52 days, with a 6-week mean symptom duration before admission.
- Pseudomonas aeruginosa was the most common pathogen (50%), showing 30% multidrug resistance; fungal pathogens were noted in 35%.
- Cranial neuropathies (8%) and CT evidence of adjacent structure involvement correlated with adverse outcomes; 80% improved, with a 12% overall mortality rate.
Conclusions:
- Limited surgical intervention and prompt microbiologic cultures are crucial for effective NOE treatment.
- Cranial neuropathies and CT-detected adjacent structure involvement are adverse prognostic indicators.
- Increasing antibiotic resistance and fungal infections may complicate future NOE management.
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