Imaging in the Diagnosis and Management of Necrotizing Otitis Externa: A Survey of Practice Patterns

To survey neurotologists and head and neck radiologists regarding use of imaging in the diagnosis and management of necrotizing otitis externa (NOE).

Cross-sectional survey study.

Online survey distributed through email to specialty society membership lists.

Neurotologists and head and neck radiologists with membership in either the American Neurotology Society or The American Society of Head and Neck Radiology.

Responses to survey consisting of two demographic and seven clinically oriented questions related to the use of imaging in the diagnosis and management of NOE.

One hundred thirty-six participants responded to the survey. The imaging modality of choice in establishing the diagnosis of NOE selected by the respondents was computed tomography (CT) (37.5%) followed by technetium scintigraphy (21.3%). Magnetic resonance imaging (MRI) was the preferred investigation by 41.9% of participants for determining extent of disease. Gallium scanning was the imaging modality preferred by 32.4% of respondents for determining when to cease medical therapy. Ninety-five percent of participants responded that CT scans were always or frequently used in the diagnosis and management of NOE compared with 72.8% for MRI, 34.5% for gallium scans, and 34.2% for technetium scans.

There is considerable heterogeneity in the preferred imaging modalities used in the diagnosis and management of NOE. CT and MRI are the preferred contemporary modalities used by many physicians, demonstrating a shift away from the historic use of nuclear medicine scans.