Necrotising otitis externa: clinical profile and management protocol

Lambor, Dheeraj; Das, Chandi; Goel, H. C.; Tiwari, Markandeya; Lambor, Swati; Fegade, Mayuresh

doi:10.1017/s0022215113002259

Cited by 20 publications

(23 citation statements)

References 47 publications

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“…This supports our data and our conclusions [9] . Our mortality rate is significantly lower (2.4%) than that of other studies (14.8%), possibly due to the fact that these patients are managed jointly with infectious diseases [5] .…”

Section: Discussioncontrasting

confidence: 74%

“…In common with other studies, the most common causative organism was P. aeruginosa, but other organisms, such as S. aureus, are increasingly prevalent in these patients [5,10] . A French study of 32 cases of necrotizing otitis externa found that mean length of stay (18.2±8.7 vs. 11.6±6.9 days, p=0.03) and duration of antibiotic therapy (9.4±3.2 vs. 5.8±0.7 weeks, p<0.001) were significantly lower after 2009 when a management protocol for necrotizing otitis externa was introduced.…”

Section: Discussionsupporting

confidence: 73%

“…This emphasizes the need for multidisciplinary advice from microbiology and infectious diseases. We have shown that early treatment results in lower morbidity, and indeed our mortality rates are lower than previously published data [5] . Our data also suggest that CRP can be used as a marker to demonstrate response to treatment, but this should be combined with clinical and radiological findings.…”

Section: Discussionsupporting

confidence: 58%

“…Recent analysis of National Hospital Episode Statistics data shows a six-fold increase in the number of cases of necrotizing otitis externa in the UK from 1999 (n=67) to 2013 (n=421) [4] . It is most common in elderly diabetic patients and the immunocompromised, although it can also occur in non-diabetics, young diabetics, patients on cytotoxic drugs, and infants [5] .…”

Section: Introductionmentioning

confidence: 99%

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Management of Necrotizing Otitis Externa: Our Experience with Forty-Three Patients

2017

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OBJECTIVE:To assess the impact of the introduction of a dedicated management protocol of necrotizing otitis externa patients with joint care between otorhinolaryngology and infectious diseases. MATERIALS and METHODS:Retrospective review of case notes and the otorhinolaryngology department database of all adults admitted with necrotizing otitis externa at our teaching hospital over a 5-year period. The patients were split into two groups (first group of 10 patients prior to the introduction of the dedicated management protocol, and a second group of 33 patients managed after the introduction of this protocol). RESULTS:Of the 43 patients included in the study, diabetes mellitus was present in 83.7%. Pseudomonas aeruginosa was grown in 67.4% of patients. All 43 patients underwent computed tomography and magnetic resonance imaging (with contrast) scans. Surgical intervention was undertaken in 25.6% of patients. Mean follow-up was 10 months (SD, ±7 months). Of the 43 patients, 79.1% made a full recovery and were discharged. Relapse occurred in 9.3% of patients. One patient died because of a myocardial infarction 4 months after treatment. The mean length of stay was significantly lower after the protocol was introduced (25.6±5.3 vs. 14.2±3.8 days, p=0.001), and the duration of treatment was also significantly lower after the protocol (21.2±6.8 vs. 14.3±4.3 weeks, p=0.01). CONCLUSION:The introduction of a dedicated management protocol and joint care with otorhinolaryngology and infectious diseases resulted in improved care and decreased length of stay in patients. Early diagnosis and involvement with the relevant teams as well as prompt intervention are the key factors that reduce morbidity and mortality.

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Section: Discussioncontrasting

confidence: 74%

Section: Discussionsupporting

confidence: 73%

Section: Discussionsupporting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

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Management of Necrotizing Otitis Externa: Our Experience with Forty-Three Patients

2017

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“…9 This increase seems to be related to an increasing elderly population, and the increase in the incidence of diabetes. This condition is frequently clinically challenging, 10,11 and clinical teams may have to devote more time to the management of affected patients.…”

mentioning

confidence: 99%