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The evolving treatment of necrotizing external otitis
D H Kraus1, S J Rehm, S E Kinney
1Department of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, OH 44195-5034.
The Laryngoscope
|September 1, 1988
Summary
Necrotizing external otitis, a severe Pseudomonas infection, is effectively treated with systemic antibiotics, reserving surgery for resistant cases. This approach achieved a 90% cure rate in elderly diabetic patients.
Area of Science:
- Infectious Diseases
- Otolaryngology
- Diabetic Complications
Background:
- Necrotizing external otitis (NEO), or malignant external otitis, is a severe Pseudomonas infection.
- It primarily affects elderly diabetic patients, involving the external auditory canal and skull base.
- Historically, radical surgery was the main treatment, but this has evolved.
Purpose of the Study:
- To review the diagnostic approach, classification, and treatment of NEO.
- To evaluate the effectiveness of modern treatment strategies, emphasizing systemic antibiotics.
- To report outcomes from a recent cohort treated at the Cleveland Clinic Foundation.
Main Methods:
- Retrospective review of 19 patients with NEO treated over 8 years.
- Focus on aggressive systemic antibiotic therapy as the primary treatment modality.
- Surgery was reserved for medically refractory cases.
Main Results:
- A 90% cure rate was achieved with the described treatment approach.
- Systemic antibiotic therapy proved highly effective in most patients.
- The study outlines diagnostic criteria and disease classification.
Conclusions:
- Aggressive systemic antibiotic therapy is the current treatment of choice for NEO.
- Surgery is indicated only for disease resistant to medical management.
- This modern approach yields high cure rates in affected patients.