Effective Inexpensive Management of Necrotizing Otitis Externa Is Possible in Resource-Poor Settings

Abstract

Introduction: Necrotizing otitis externa resolves best with antimicrobial treatment. How to care for these patients and monitor their resolution remains a problem. Our protocol in Bangalore can manage these patients inexpensively and well. Materials and Methods: Patients who were referred to our patients became the subjects for this paper. They were managed through our protocol, which consists of IV ciprofloxacin and meropenem, weekly labs, weekly examinations, and photodocumention. Results: Fifty-one people presented with necrotizing otitis externa (NOE) between October 2015 and November 2017 and completed our entire protocol. Forty-six had complete resolution of their disease, while 5 had to undergo surgical removal of necrotic bone. Six of 8 patients with facial weakness had improvement in their House-Brackmann scores. Reduction of self-reported nocturnal pain, dissolution of ear canal granulations, and normalization of the erythrocyte sedimentation rate (ESR) proved to be the most accurate indicators of disease regression. Conclusion: Patients are monitored closely with review of their otalgia, examination of their canal, repeated ESRs, effective control of their diabetes, and radiological imaging. All this can be done in a resource-poor country, which in turn serves as a model for the wealthier nations.

Emerging themes in necrotising otitis externa: a scoping review of the literature from 2011 to 2020 and recommendations for future research

“…Resolution of necrotising otitis externa has been variously defined as: the absence of clinical signs or symptoms a month after antibiotic therapy completion; 19 the absence of symptoms for more than 2 weeks, with normalisation of inflammatory markers and without relapse within 12 weeks; 42 and nocturnal otalgia resolution. 17 It is agreed that prognostic factors remain elusive.…”

“…A number of studies have described the use of surgery for specific sequelae of necrotising otitis externa, including facial or other cranial nerve palsies, abscesses, persistent otalgia, 15 canalplasty, 23 and ventilation tube insertion for glue ear. 17…”

“…Twenty-five studies included explanations of how a diagnosis of necrotising otitis externa was made. Some used Cohen and colleagues' criteria 2 to identify cases, [15][16][17][18] which other authors considered to be outdated. Other studies described modifications of Cohen and colleagues' criteria.…”

“…60 The optimisation of glycaemic control was explicit in only three published protocols, as was analgesia. Honnurappa et al 17 described a treatment protocol in which all patients were started on muscle relaxants, antacids, and multivitamins with zinc. Several studies recommended the commencement of antifungals in the absence of clinical improvement.…”

Systematic review of the diagnosis and management of necrotising otitis externa: Highlighting the need for high‐quality research

“…Many 'general' articles administered antimicrobials by both IV and oral routes, although a minority reported exclusive use of either IV (22%, 11/51) 4,18,[20][21][22]24,33,35,58,60,61 or oral antimicrobials (8%, 4/51). 26,[28][29][30] The switch from IV to oral was typically described as driven by 'clinical response', but there was no data on when this switch can be safely made, and no articles compared the efficacy of different routes.…”