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A retrospective review and multi-specialty, evidence-based guideline for the management of necrotising otitis externa

Published online by Cambridge University Press:  05 June 2020

M E Hopkins ,
A Bennett ,
N Henderson ,
K F MacSween ,
D Baring  and
R Sutherland
M E Hopkins*
Affiliation:
Department of ENT, NHS Lothian, Edinburgh, Scotland, UK
A Bennett
Affiliation:
Department of ENT, NHS Lothian, Edinburgh, Scotland, UK
N Henderson
Affiliation:
Department of Microbiology, NHS Lothian, Edinburgh, Scotland, UK
K F MacSween
Affiliation:
Department of Microbiology, NHS Lothian, Edinburgh, Scotland, UK
D Baring
Affiliation:
Department of ENT, NHS Lothian, Edinburgh, Scotland, UK
R Sutherland
Affiliation:
Department of Infectious Diseases, NHS Lothian, Edinburgh, Scotland, UK
*
Author for correspondence: Mr Michael E Hopkins, ENT Department, NHS Lothian, Lauriston Buildings, Lauriston Place, EdinburghEH3 9DE, Scotland, UK E-mail: michael.hopkins6@nhs.net
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Abstract

Background

Necrotising otitis externa is a progressive infection of the external auditory canal which extends to affect the temporal bone and adjacent structures. Progression of the disease process can result in serious sequelae, including cranial nerve palsies and death. There is currently no formal published treatment guideline.

Objective

This study aimed to integrate current evidence and data from our own retrospective case series in order to develop a guideline to optimise necrotising otitis externa patient management.

Methods

A retrospective review of necrotising otitis externa cases within NHS Lothian, Scotland, between 2013 and 2018, was performed, along with a PubMed review.

Results

Prevalent presenting signs, symptoms and patient demographic data were established. Furthermore, features of cases associated with adverse outcomes were defined. A key feature of the guideline is defining at-risk patients with initial intensive treatment. Investigations and outcomes are assessed and treatment adjusted appropriately.

Conclusion

This multi-departmental approach has facilitated the development of a succinct, systematic guideline for the management of necrotising otitis externa. Initial patient outcomes appear promising.

Keywords

Otitis ExternaCranial Nerve DiseasesRetrospective StudiesTemporal Bone
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 6 , June 2020 , pp. 487 - 492
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

Mr M Hopkins takes responsibility for the integrity of the content of the paper

Presented as a poster (and awarded the accolade of ‘Best Poster’) at the ENT-UK Annual Meeting, 13 September 2019, London, UK.

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