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The significance of tissue biopsy for fungi in necrotizing otitis externa

  • Otology
  • Published:
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Abstract

Introduction

The conventional treatment for necrotizing otitis externa (NOE) is prolonged anti-pseudomonas therapy, with surgical treatment in non-responsive patients. The aim of the present study is to describe the course of management of patients with non-responsive NOE undergoing hyperbaric oxygen therapy (HBOT), and to investigate the importance of tissue biopsy for fungi in this group of patients.

Materials and methods

A retrospective study conducted between January 2010 and December 2013 at an Otolaryngology Head and Neck Surgery Department. Included were all 52 patients with NOE referred to our Medical Centre for further treatment including HBOT.

Results

Fifty-two consecutive patients, 29 men and 23 women, with a mean age of 70.6 years, were included in our study. Twenty seven (51.9%) underwent surgical debridement. No significant difference was found between the group having surgical intervention, and those who did not, with regard to sex, age, comorbidities, cranial nerve involvement or laboratory results. However, those who had surgical intervention had a statistically significant higher rate of fungal infection (P = 0.049). After completing 7 weeks of HBOT, a significantly lower WBC count was observed in the fungus-infected group (7000 vs 7.800, P = 0.03), and a tendency towards lower CRP levels in the fungus-infected group (16 vs 58, P = 0.087).

Conclusion

Patients with NOE should have a comprehensive surgical intervention when delayed healing is observed, because proper fungal culturing might change the course of treatment and improve prognosis.

Level of evidence

4.

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There is no direct or indirect commercial financial incentive associated with publishing the article; there is no extra-institutional funding.

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Authors and Affiliations

  1. Departments of Otolaryngology Head and Neck Surgery, Assaf Harofeh Medical Center, 70300, Zerifin, Israel

    Rani Abu Eta, Haim Gavriel, Ephraim Eviatar & Eyal Yeheskeli

  2. Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel

    Rani Abu Eta, Haim Gavriel, Ephraim Eviatar & Eyal Yeheskeli

  3. Department of Surgical Oncology, Peter MacCallum Cancer Institute, Melbourne, Australia

    Haim Gavriel & Kleid Stephen

Authors
  1. Rani Abu Eta
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  2. Haim Gavriel
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  3. Kleid Stephen
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  4. Ephraim Eviatar
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  5. Eyal Yeheskeli
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Correspondence to Haim Gavriel.

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Abu Eta, R., Gavriel, H., Stephen, K. et al. The significance of tissue biopsy for fungi in necrotizing otitis externa. Eur Arch Otorhinolaryngol 275, 2941–2945 (2018). https://doi.org/10.1007/s00405-018-5151-9

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  • DOI: https://doi.org/10.1007/s00405-018-5151-9

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