Necrotizing Otitis Externa

Abstract

To carry out a systematic review of scientific evidence available about necrotizing otitis externa, emphasizing epidemiologic data, diagnosis criteria, treatment protocols, follow-up criteria, prognosis factors, and chronologic evolution. PubMed/MEDLINE and the Cochrane Database of Systematic Reviews were searched for publications in English and French languages, between 1968 and October 1, 2011. We included publications of all types including at least 6 cases. We excluded publications focused on cranial base osteomyelitis not originating from the external ear and publications limited to a specific population. We assessed publication quality according to international guidelines. For each publication, data were entered in a spreadsheet software for analysis. We excluded individual data already published in other studies or reviews. Our review revealed the absence of strong scientific evidence regarding diagnosis criteria, treatment protocols and follow-up criteria. This implies the use of highly empirical indexes of suspicion in clinical practice. Our review confirmed the existence of a typical but not exclusive population at risk (aged, male, and diabetic patient) and also revealed major issues: lack of primary prevention in population at risk, delays before referral and management, bacteriologic issues caused by antibiotic misuse (agent identification problems, rise of resistant strains), persistence of recurrent cases. A better diffusion of medical information should help improve the management of this severe disease.