The treatment of necrotizing otitis externa with a combination of surgery, antibiotics, specific immunoglobulins and hyperbaric oxygen therapy. Results of the Ulm Treatment Concept

Abstract

Even today, necrotizing otitis externa is still a life-threatening condition. The standard treatment concepts based on antibiotic therapy, topical treatment and--if necessary--surgical debridement of necrotic tissue, remain ineffective in many cases. In advanced stages, necrotizing otitis externa can therefore be expected to result in severe functional impairment or even a fatal outcome. We describe our experience with a multimodal treatment concept that we have been using with great success at the Federal Armed Forces Hospital in Ulm since 1987. This treatment is based on four pillars: 1. Surgical debridement, 2. Use of a combination of antibiotics, and 3. Administration of specific immunoglobulins, accompanied by, 4. Hyperbaric oxygen therapy Over a period of more than 5 years 16 of the 22 patients treated on the basis of this multimodal concept remained free of recurrences. In addition, significant reductions in analgesic use and in the insulin doses needed by diabetic patients were possible. The treatment concept under scrutiny has proved particularly successful. The various modes involved and the results of this combined therapy are discussed.