Necrotizing Otitis Externa: Four theories behind the 15-year astronomic rise of this uncommon infection

Abstract

INTRODUCTION: NECROTIZING OTITIS EXTERNA (NOE) IS A SEVERE, LIFE THREATENING PROPAGATING OSTEOMYELITIS OF THE SKULL BASE THAT ORIGINATES FROM A SEVERE OTITIS EXTERNA. THIS RARE CONDITION MAY NOT BE AS UNCOMMON AS ONCE UNDERSTOOD. EPIDEMIOLOGIC DATA REVEALS AN UNEXPECTED AND DRASTIC RISE IN THE NUMBER OF REPORTED CASES OVER THE LAST 15 YEARS. USING NATIONAL DATA AND PUBLISHED LITERATURE, WE EXPLORE FOUR THEORIES BEHIND THE RISE IN INCIDENCE OF THIS CONDITION. Methods: A quantitative descriptive study was undertaken using epidemiological data obtained from the Hospital Episode Statistics (HES) database. NOE cases reported between 2002 – 2017 were compiled and analyzed. Using these results and current evidence within the published literature, four theories were formulated and explored to explain the upward trend in incidence. Results: There were a total of 7,327 NOE cases reported within the 15-year time period. The majority of cases (60%) occurred in the elderly (Age 75+) with a 5:2 male predominance. Mean length of stay and mean total bed days were 16.3 and 5,019 days, respectively. Discussion: The number of NOE cases has increased by more than 1000% within the 15-year time period, from 123 cases in 2002 to 1,405 in 2017. We theorize that this increase maybe due to: (1) the rising prevalence of diabetes (2) the increase in antibiotic resistance (3) the rising ageing population (4) improved physician awareness of NOE

Examining the utility of nuclear medicine imaging in the diagnosis and management of necrotising otitis externa

“…It is a condition seen more frequently in the elderly, often with diabetes, and typically associated with Pseudomonas aeruginosa 1,2 . Evidence from the UK Hospital Episodes Statistics (HES) reveals a 1042% rise in the incidence of MOE 3 …”