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Necrotising otitis externa – is a poor outcome predictable? The application of a diagnosis-based scoring system in patients with skull base osteomyelitis

Published online by Cambridge University Press:  29 November 2021

D M Rojoa ,
F J Raheman ,
Y Saman ,
B Mettias ,
S Das  and
P A Rea
D M Rojoa*
Affiliation:
Department of Otolaryngology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
F J Raheman
Affiliation:
Department of Otolaryngology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
Y Saman
Affiliation:
Department of Otolaryngology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
B Mettias
Affiliation:
Department of Otolaryngology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
S Das
Affiliation:
Department of Otolaryngology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
P A Rea
Affiliation:
Department of Otolaryngology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK Balance Medicine, De Montfort University, Leicester, UK Department of Neuroscience and Informatics, University of Leicester, UK
*
Author for correspondence: Dr Djamila M Rojoa, Department of Otolaryngology, Leicester Royal Infirmary, Leicester LE1 5WW, UK E-mail: Djamila.rojoa@doctors.org.uk
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Abstract

Background

The increased incidence of necrotising otitis externa over the last decade has had a significant burden on healthcare providers. Several factors may affect outcome, and stratifying risk may allow personalised treatment.

Method

Retrospectively identified patients were prospectively surveyed over 12 months. The Cox proportional hazards model was used to identify predictors of poor prognosis.

Results

Twenty-six patients with necrotising otitis externa (average age of 80 years) were admitted from 2018 to 2019. At one year, 19 per cent mortality was observed. A high Charlson Comorbidity Index was associated with increased mortality (p = 0.03), prolonged in-patient stay (p = 0.047) and increased odds of adverse outcomes (odds ratio = 1.48, 95 per cent confidence interval = 0.26–2.67, p = 0.019). The Charlson Comorbidity Index in our prognostic model was validated using the receiver operating characteristic curve (area under the curve = 0.76). Charlson Comorbidity Index score of 5 or more independently predicted one-year morbidity and mortality (hazard ratio = 1.30, 95 per cent confidence interval = 0.94–1.79, p = 0.03).

Conclusion

Risk-stratifying patients may enable clinicians to holistically counsel patients and tailor their treatment to improve their prognosis and subsequently alleviate the burden of necrotising otitis externa.

Keywords

Otitis ExternaSkull BaseOsteomyelitisComorbidityRisk AssessmentPrognosis

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 5 , May 2022 , pp. 379 - 385
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr D Rojoa takes responsibility for the integrity of the content of the paper

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