Necrotizing Otitis Externa - Analysis of 83 Cases: Clinical Findings and Course of Disease

Objectives: Evaluate the relationship between clinical findings and course of disease among patients with necrotizing otitis externa (NOE). Study Design: Retrospective case series review. Setting: Tertiary referral center. Patients: Adult patients with no previous history of chronic ear disease, hospitalized due to NOE between the years 1990 to 2015. Main Outcome Measures: 1) Duration of hospitalization and 2) necessity for surgery. Results: Eighty-one patients were included in the study, corresponding to 83 effected ears. Thirty-two patients (38.5%) were hospitalized longer than 20 days and 20 patients (24.0%) underwent surgery. Otalgia was the most common complaint (n = 71, 85.5%). Pseudomonas Aeruginosa (PA) was the most common isolated bacteria (n = 40, 48.1%). Shifting incidence of culture results was noted, as rates of PA NOE decreased and rates of sterile culture and fungal NOE increased. Duration of complaints and presence of aural discharge at admission were associated with prolonged hospitalization (p = 0.010, p = 0.011, respectively). Advanced age, duration of hospitalization, and rates of readmission were associated with surgery (p = 0.037, p < 0.001, p < 0.001 respectively). Conclusions: Duration of complaints and presence of aural discharge may indicate advanced NOE and require longer in-hospital treatment. Elderly patients are at increased risk for conservative treatment failure and are more likely to require surgery. With shifting incidence of pathogens, a wider empirical treatment covering nontraditional pathogens should be considered.