[Diagnosis and management of necrotizing otitis externa]

Necrotizing otitis externa (NOE) is a rare, potentially life-threatening invasive infection of the external auditory canal that predominantly affects elderly and immunocompromised individuals-particularly those with diabetes mellitus. The disease may progress to skull base osteomyelitis and can lead to severe complications such as cranial nerve palsy, meningitis, or dural sinus thrombosis. The most common causative pathogen is Pseudomonas aeruginosa, although invasive fungal infections are increasingly recognized. The primary therapeutic strategy involves extended administration of pathogen-specific systemic antimicrobial agents. Surgical intervention may be required for complicated clinical courses. For monitoring disease progression and evaluating the therapeutic response, fluorodeoxyglucose positron-emission tomography (18F-FDG-PET) in combination with computed tomography (CT) or magnetic resonance imaging (MRI) of the temporal bone has proven valuable. Lifelong closeknit otolaryngological follow-up is essential to detect recurrences early.