Necrotizing otitis externa: report of 36 cases

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Published Feb 7, 2011
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Vol. 89 No. 2 (2011): Issue Feb 2011

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Elyès Gassab
Nesrine Krifa
Najoua Sayah
Noura Khaireddine
Jamel Koubaa
Aicha Gassab

Abstract

Background: Necrotizing otitis externa is a potentially lethal form of otitis externa which occurs mainly in elderly diabetic.
Aim: To study the clinical, diagnostic and therapeutic aspects of necrotizing otitis externa and to describe the outcomes of this
disease.
Methods:We report in this retrospective study, a series of 36 patients treated in our department for necrotizing otitis externa over a period of 9 years.
Results: Our series consisted of 34 diabetics. The average age of our patients was 62 years. The diagnosis was based on clinical, biological and bacteriological data and on imaging findings. A medical treatment based on a systemic antibiotic therapy combining a third generation cephalosporin to a fluoroquinolone was prescribed in 24 cases and to an aminoglycoside in 12 cases. In addition, a local treatment was performed daily and included meticulous cleaning of the external auditory canal and topical application of antimicrobial agents. Surgical debridement of infected soft tissues and bone sequestra was indicated in 8 cases because of the lack of improvement with medical treatment. Only one patient underwent hyperbaric oxygen therapy. The cure rate was estimated at 86%. Only one death was noted.
Conclusion: Necrotizing otitis externa is a severe infection. Its prognosis has improved markedly since the advent of antibiotics effective on Pseudomonas aeruginosa. Its management must be started without delay and its treatment must be prolonged.

Keywords:

Necrotizing otitis externa, Pseudomonas aeruginosa, osteomyelitis, antibiotic therapy, computed tomographic, computed tomographic scan, scintigraphy

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