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Exploring theories for the exponential 16-year rise in incidence of necrotising otitis externa in England

Published online by Cambridge University Press:  10 January 2022

S Linton  and
E Stapleton Open the ORCID record for E Stapleton [Opens in a new window]
S Linton
Affiliation:
Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
E Stapleton*
Affiliation:
Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
*
Author for correspondence: Dr Emma Stapleton, Department of Otolaryngology, Peter Mount Building, Manchester Royal Infirmary, Oxford Road, ManchesterM13 9WL, UK E-mail: Emmastapleton@doctors.org.uk
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Abstract

Background

Necrotising otitis externa is a severe, life-threatening infection. Epidemiological data demonstrate a dramatic rise in reported cases in England from 2002 to 2017. The reasons for this remain elusive.

Methods

A quantitative descriptive study was undertaken using epidemiological data from the Hospital Episode Statistics database. Cases from 2002 to 2017 were compiled and analysed. Four potential theories were explored to explain the rise in incidence.

Results

Within the 16-year period, 7327 necrotising otitis externa cases were reported. Annual necrotising otitis externa incidence increased 1142 per cent within the 16-year period, from 123 recorded cases in 2002 to 1405 cases in 2017. This correlates with an increasing prevalence of diabetes, an ageing population and likely increased physician awareness of necrotising otitis externa. There is insufficient evidence to support antibiotic resistance as a significant associated factor.

Conclusion

Correlation does not imply causation. It is likely that a combination of factors is contributing to the rise in necrotising otitis externa incidence, including increased physician recognition, diagnosis and accurate clinical coding.

Keywords

Otitis ExternaOsteomyelitisDiabetes MellitusImmunosuppression
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 10 , October 2022 , pp. 925 - 929
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr E Stapleton takes responsibility for the integrity of the content of the paper

This paper was presented (and awarded the North of England Otolaryngology Society Prize for best trainee presentation) at the North of England Otolaryngology Society Autumn meeting, 23 October 2019, Wakefield, UK.

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