Abstract
Purpose
Treatment for necrotizing otitis externa (NOE) includes long term antibiotic and surgery in selected cases. Indications and extent of surgery, however, are still not defined. The aims of this study were: (1) present our experience in surgery for NOE (2) compare high-resolution computer tomography and perioperative findings (3) suggest recommendations for indications and extent of surgery.
Methods
A retrospective case series study was conducted in a tertiary referral center. Patients hospitalized due to NOE between the years 1990–2015 and underwent surgery were included.
Results
Twenty patients were included in the study. HRTBCT was performed in 17 patients. Most common radiological findings included mastoid fullness (n = 13, 76.4%) and edema of external ear canal (n = 12, 70.5%). Surgical indications included lack of response to treatment (n = 18) and facial nerve palsy (n = 2). Seven patients underwent local debridement. Most common operative findings included soft tissue necrosis (n = 4, 57.1%) and gross bony destruction of the external ear canal (n = 2, 28.5%). Thirteen patients underwent tympanomastoid surgery. Most common operative findings included granulation tissue in the mastoid (n = 7, 53.8%) and mastoid bony erosion (n = 4, 30.7%). Facial canal involvement was seen in four patients (30.7%).
Conclusion
This is the first study to describe a large group of surgically treated NOE. Initial surgical approach should be based on clinical and HRTBCT findings. Minimal HRTBCT findings may be addressed with local debridement. Severe HRTBCT findings should be addressed with canal wall up mastoidectomy as the minimal surgical procedure. Further extent should be decided based on perioperative findings.
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References
Mader JT, Love J (1982) Malignant external otitis. Arch Otolaryngol 108:38–40
Hollis S, Evans K (2011) Management of malignant (necrotising) otitis externa. J Laryngol Otol 125:1212–1217
Gruber M, Roitman A, Doweck I et al (2014) Clinical utility of a polymerase chain reaction assay in culture-negative necrotizing otitis externa. Otol Neurotol 733–736:2015
Stern Shavit S, Soudry E, Hamzany Y, Nageris B (2016) Malignant external otitis: factors predicting patient outcomes. Am J Otolaryngol 37:425–430
Visosky AM, Isaacson B, Oghalai JS (2006) Circumferential petrosectomy for petrous apicitis and cranial base osteomyelitis. Otol Neurotol 27:1003–1013
Peled C, El-Seid S, Bahat-Dinur A, Tzvi-Ran LR, Kraus M, Kaplan D (2019) Necrotizing otitis externa-analysis of 83 cases: clinical findings and course of disease. Otol Neurotol 40:56–62
Cohen D, Friedman P (1987) The diagnostic criteria of malignant external otitis. J Laryngol Otol 101:216–221
Peled C, Kraus M, Kaplan D (2018) Diagnosis and treatment of necrotizing otitis externa and diabetic foot osteomyelitis—similarities and differences. J Laryngol Otol 132:1–5
Soudry E, Joshua BZ, Sulkes J, Nageris BI (2007) Characteristics and prognosis of malignant external otitis with facial paralysis. Arch Otolaryngol Head Neck Surg 133:1002–1004
Peleg U, Perez R, Raveh D, Berelowitz D, Cohen D (2007) Stratification for malignant external otitis. Otolaryngol Head Neck Surg 137:301–305
Loh S, Loh WS (2012) Malignant otitis externa: an Asian perspective on treatment outcomes and prognostic factors. Otolaryngol Head Neck Surg 148:991–996
Soudry E, Hamzany Y, Preis M, Joshua B, Hadar T, Nageris BI (2011) Malignant external otitis: analysis of severe cases. Otolaryngol Head Neck Surg 144:758–762
Stevens SM, Lambert PR, Baker AB, Meyer TA (2015) Malignant otitis externa: a novel stratification protocol for predicting treatment outcomes. Otol Neurotol 36:1492–1498
Mahdyoun P, Pulcini C, Gahide I, Raffaelli C, Savoldelli C, Castillo L, Guevara N (2013) Necrotizing otitis externa: a systematic review. Otol Neurotol 34:620–629
Salit IE, McNeely DJ, Chait G (1985) Invasive external otitis: review of 12 cases. Can Med Assoc J 132:381–384
Sade J, Lang R, Goshen S, Kitzes-Cohen R (1989) Ciprofloxacin treatment of malignant external otitis. Am J Med 87:138S–S141
Lang R, Goshen S, Kitzes-Cohen R, Sade J (1990) Successful treatment of malignant external otitis with oral ciprofloxacin: report of experience with 23 patients. J Infect Dis 161:537–540
Pedersen HB, Rosborg J (1997) Necrotizing external otitis: aminoglycoside and beta-lactam antibiotic treatment combined with surgical treatment. Clin Otolaryngol Allied Sci 22:271Y4
Berenholz L, Katzenell U, Harell M (1619Y) Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa. Laryngoscope 112:1619Y22
Lee S, Hooper R, Fuller A, Turlakow A, Cousins V, Nouraei R (2008) Otogenic cranial base osteomyelitis: a proposed prognosis-based system for disease classification. Otol Neurotol 29:666–672
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Peled, C., Parra, A., El-saied, S. et al. Surgery for necrotizing otitis externa—indications and surgical findings. Eur Arch Otorhinolaryngol 277, 1327–1334 (2020). https://doi.org/10.1007/s00405-020-05842-x
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DOI: https://doi.org/10.1007/s00405-020-05842-x