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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2023; 27(04): e706-e712
DOI: 10.1055/s-0042-1758719
Original Research

Necrotizing Otitis Externa: A Proposal for Diagnostic and Therapeutic Approach

Marília Batista Costa 
1   Department of Otorhinolaryngology - Head and Neck Surgery, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, SP, Brazil
,
Ektor Tsuneo Onishi 
1   Department of Otorhinolaryngology - Head and Neck Surgery, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, SP, Brazil
› Author Affiliations Funding The present research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Introduction Necrotizing otitis externa has a high impact on the quality of life of patients and has shown a significant increase in its incidence in recent years. There has been a change in the profile of affected patients and a lack of consensus on the management of these patients.

Objective To develop a practical and effective care protocol to standardize the diagnostic and therapeutic management of necrotizing otitis externa.

Methods A retrospective cohort study of necrotizing otitis externa patients between January 2015 and December 2020.

Results There were 34 patients with two bilateral cases, totaling 36 ears. The mean age was 68.5, with a higher prevalence of males (76%). Diabetes was present in 97% of the samples. The involvement of cranial pairs was identified in 35% of the sample. Pseudomonas aeruginosa was the most frequent pathogen isolated, found in 50% of the cases. Among the cultures with bacterial agents isolated, 35% showed resistance to ciprofloxacin. The most frequent exam was computed tomography (94%). Hospital admission was indicated for 31 patients (91%), and ceftazidime was the most prescribed drug (35.5%). There were 11 recurrences (32%), and 12 patients (35%) had complications during treatment. Among the unfavorable outcomes, 12% persisted with some degree of peripheral facial paralysis, 6% maintained dysphagia, and 9% died of the disease.

Conclusions The present study developed a diagnostic and therapeutic protocol for the effective management of necrotizing otitis externa. This protocol is a dynamic tool and should be revised and updated as new demands emerge during its implementation.

Keywords

external otitis - skull base - osteomyelitis - diabetes mellitus - otolaryngology


Publication History

Received: 09 August 2022

Accepted: 04 September 2022

Article published online:
26 September 2023

© 2023. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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