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Necrotising Otitis Externa: Can treatment be de-escalated?
  • Michael Mather,
  • Arpita Singh,
  • Puveendran Arullendran
Michael Mather
Newcastle University Institute of Cellular Medicine
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Arpita Singh
Sunderland Royal Hospital
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Puveendran Arullendran
Sunderland Royal Hospital
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Abstract

Introduction: Necrotising otitis externa (NOE) is a severe infection of the external auditory canal and the incidence in the UK has risen dramatically in recent years. Treatment options for NOE remain contentious and can confer substantial risks. Osteomyelitis at other anatomical sites has shown promising outcomes when treated with early debridement and short-course antimicrobial therapy. Application of this paradigm in NOE may offer distinct advantages for patients but this remains to be demonstrated. Methods: A prospective cohort analysis of patients with NOE admitted to Sunderland Royal Hospital between January-September 2019. Previous treatment, examination findings, medical history, relevant microbiology and imaging results were document. Results: A total of eight patients were included (age 58-87, male:female 6:2). Most (6/8) patients had type 2 diabetes; 5/6 had poor glycaemic controls (HbA1c > 48mmol/mol). 4/8 patients had undergone previous ear syringing. Pain was present on average for 40 days prior to admission (range 14-60 days). Otoscopy and CT findings were highly variable between cases. Most (5/8) patients grew P. aeruginosa on bacterial swabs. 5/8 patients were treated with short course antimicrobial therapy (3/8 prolonged). 5/8 received early surgical debridement. 7/8 patients were successfully treated – 1 patient died of concurrent haematological malignancy. Conclusion: A standardised protocol for NOE has facilitated a consistent approach to treatment at our centre. Selected cases have good outcomes with short course antimicrobial therapy and early surgical debridement, but this analysis was not powered to determine statistical significance. A randomised trial with more patients would confirm non-inferiority of short course antimicrobial therapy and early surgical debridement in NOE.