Errors in the Diagnosis and Management of Necrotizing Otitis Externa

Abstract

Necrotizing otitis externa (NOE) is a life-threatening condition that may be difficult to distinguish from other clinical entities. The purpose of this study was to assess the pitfalls associated with contemporary diagnosis and management of NOE. Retrospective chart review. Patients given the diagnosis of NOE or one of its typical presenting complaints over the past 14 years were identified by diagnostic and radiology codes. Charts were reviewed for history, findings, treatment, and outcomes. Fifty-one patients with NOE were identified. The annual number of cases rose throughout the study period. A risk factor was known in 46. The gallium SPECT study was accurate for the presence (44 of 46 patients) and resolution of disease. Prolonged systemic antimicrobial therapy (mean 15 weeks, range 4-59) was required. Microbial cultures influenced therapy in only 50%. Two diabetic men died with disease (a 44 year old with a renal transplant and an 87 year old with severe renal failure). Of the cases seen at the request of otolaryngologists, 68% were for indications other than NOE (eg, chronic otitis media). With a known risk such as diabetes, the mean time to diagnosis was 6.9 months. NOE remains a life-threatening condition that requires prolonged antimicrobial therapy. Its incidence may be on the rise. NOE may mimic more benign conditions. NOE must be considered in all patients with temporal bone inflammation, especially those with risk factors and those that fail to improve with more conservative measures.