Surgery for necrotizing otitis externa-indications and surgical findings

Area of Science:

• Otolaryngology
• Neurosurgery
• Radiology

Background:

• Necrotizing otitis externa (NOE) treatment involves long-term antibiotics and surgery.
• Surgical indications and extent for NOE remain undefined.

Purpose of the Study:

• To present surgical experience in NOE.
• To compare high-resolution computed tomography (HRCT) and perioperative findings.
• To recommend indications and extent for NOE surgery.

Main Methods:

• Retrospective case series of 20 patients with NOE who underwent surgery between 1990-2015.
• HRCT was performed in 17 patients.
• Surgical procedures included local debridement and tympanomastoid surgery.

Main Results:

• Common HRCT findings: mastoid fullness (76.4%) and external ear canal edema (70.5%).
• Surgical indications: lack of treatment response (n=18) and facial nerve palsy (n=2).
• Operative findings included soft tissue necrosis (57.1%), bony destruction (28.5%), granulation tissue (53.8%), and mastoid bony erosion (30.7%). Facial canal involvement occurred in 30.7%.

Conclusions:

• This study describes a large cohort of surgically treated NOE patients.
• Surgical approach should integrate clinical and HRCT findings.
• Minimal HRCT findings may be managed with local debridement; severe findings warrant canal wall up mastoidectomy, with further extent determined intraoperatively.