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Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistics trends

Published online by Cambridge University Press:  20 May 2015

G Chawdhary ,
N Liow ,
J Democratis  and
O Whiteside
G Chawdhary*
Affiliation:
Department of ENT, Wexham Park Hospital, Slough, UK
N Liow
Affiliation:
Department of Microbiology, Wexham Park Hospital, Slough, UK
J Democratis
Affiliation:
Department of Microbiology, Wexham Park Hospital, Slough, UK
O Whiteside
Affiliation:
Department of ENT, Wexham Park Hospital, Slough, UK
*
Address for correspondence: Dr Gaurav Chawdhary, ENT Department, Wexham Park Hospital, Slough, Berkshire, SL2 4HL, UK E-mail: gauravchawdhary@gmail.com
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Abstract

Background:

Necrotising (malignant) otitis externa is a severe infection causing temporal bone osteomyelitis. Although rare, our experience (reported herein) shows local doubling of cases in 2013. Hospital Episodes Statistics data for England over 14 years also indicate increased incidence nationally. Specific learning points in management are also discussed.

Methods:

A retrospective review was conducted of patients admitted in 2013 to Wexham Park Hospital, Slough, UK (catchment population, 450 000). In addition, the UK Government Hospital Episodes Statistics data were interrogated.

Results:

There were five cases of necrotising (malignant) otitis externa in 2013, representing a local doubling on previous years. The mean age of patients was 82 years. All cultures grew Pseudomonas aeruginosa; no isolates were antibiotic resistant. All patients responded to systemic anti-pseudomonals on clinical, biochemical and radiological parameters. Hospital Episodes Statistics data showed a six-fold increase in the number of cases from 1999 (n = 67) to 2013 (n = 421).

Conclusion:

Our experience suggests increasing necrotising (malignant) otitis externa incidence, and retrospective analysis of Hospital Episodes Statistics data supports this observation. Necrotising (malignant) otitis externa poses challenges in management, as exemplified in our cases, requiring a high index of suspicion and early aggressive treatment to achieve cure.

Keywords

OsteomyelitisOtitis ExternaTemporal BonePseudomonas aeruginosaIncidenceEpidemiology
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 6 , June 2015 , pp. 600 - 603
Copyright
Copyright © JLO (1984) Limited 2015 

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