Surgical management of benign necrotizing otitis externa

Benign necrotizing otitis externa (BNOE) is a rare condition of unknown aetiology which is characterized by the formation of an avascular bony sequestrum of the tympanic plate. The vascular supply of the tympanic plate is easily compromised as demonstrated by the development of avascular necrosis in radionecrosis of the tympanic plate and malignant otitis externa. Recognition of BNOE as distinct from malignant otitis externa and carcinoma of the external ear is important as the treatment differs greatly. BNOE also forms an important part of the differential diagnosis of recalcitrant otitis externa. Management of BNOE has been unclear with long-term medical treatment being advocated. In this series of five patients, the surgical management of four patients with BNOE is described. Surgery was successful in all these patients and is advocated as an alternative to medical management.