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Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistics trends

Published online by Cambridge University Press:  20 May 2015

G Chawdhary ,
N Liow ,
J Democratis  and
O Whiteside
G Chawdhary*
Affiliation:
Department of ENT, Wexham Park Hospital, Slough, UK
N Liow
Affiliation:
Department of Microbiology, Wexham Park Hospital, Slough, UK
J Democratis
Affiliation:
Department of Microbiology, Wexham Park Hospital, Slough, UK
O Whiteside
Affiliation:
Department of ENT, Wexham Park Hospital, Slough, UK
*
Address for correspondence: Dr Gaurav Chawdhary, ENT Department, Wexham Park Hospital, Slough, Berkshire, SL2 4HL, UK E-mail: gauravchawdhary@gmail.com
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Abstract

Background:

Necrotising (malignant) otitis externa is a severe infection causing temporal bone osteomyelitis. Although rare, our experience (reported herein) shows local doubling of cases in 2013. Hospital Episodes Statistics data for England over 14 years also indicate increased incidence nationally. Specific learning points in management are also discussed.

Methods:

A retrospective review was conducted of patients admitted in 2013 to Wexham Park Hospital, Slough, UK (catchment population, 450 000). In addition, the UK Government Hospital Episodes Statistics data were interrogated.

Results:

There were five cases of necrotising (malignant) otitis externa in 2013, representing a local doubling on previous years. The mean age of patients was 82 years. All cultures grew Pseudomonas aeruginosa; no isolates were antibiotic resistant. All patients responded to systemic anti-pseudomonals on clinical, biochemical and radiological parameters. Hospital Episodes Statistics data showed a six-fold increase in the number of cases from 1999 (n = 67) to 2013 (n = 421).

Conclusion:

Our experience suggests increasing necrotising (malignant) otitis externa incidence, and retrospective analysis of Hospital Episodes Statistics data supports this observation. Necrotising (malignant) otitis externa poses challenges in management, as exemplified in our cases, requiring a high index of suspicion and early aggressive treatment to achieve cure.

Keywords

OsteomyelitisOtitis ExternaTemporal BonePseudomonas aeruginosaIncidenceEpidemiology
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 6 , June 2015 , pp. 600 - 603
Copyright
Copyright © JLO (1984) Limited 2015 

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References

1Chandler, JR. Malignant external otitis. Laryngoscope 1968;78:1257–94CrossRefGoogle ScholarPubMed
2Office for National Statistics. What Does the 2011 Census Tell Us About Older People? Full infographic. In: http://www.ons.gov.uk/ons/rel/census/2011-census-analysis/what-does-the-2011-census-tell-us-about-older-people-/what-does-the-2011-census-tell-us-about-older-people--full-infographic.html [19 January 2014]Google Scholar
3Diabetes, UK. Diabetes prevalence 2012 (March 2013). In: http://www.diabetes.org.uk/About_us/What-we-say/Statistics/Diabetes-prevalence-2012 [19 January 2014]Google Scholar
4Health and Social Care Information Centre. Hospital Episode Statistics, Admitted Patient Care, England. In: http://www.hscic.gov.uk/searchcatalogue?q=title%3A%22Hospital+Episode+Statistics%2C+Admitted+patient+care+-+England%22&area=&size=10&sort=Relevance [5 July 2014]Google Scholar
5HES for physicians: A guide to the use of information derived from HES. In: https://www.rcplondon.ac.uk/sites/default/files/documents/hes_for_physicians_guide.pdf [2 April 2015]Google Scholar
6Mahdyoun, P, Pulcini, C, Gahide, I, Raffaelli, C, Savoldelli, C, Castillo, L et al. Necrotizing otitis externa: a systematic review. Otol Neurotol 2013;34:620–9CrossRefGoogle ScholarPubMed
7Carfrae, MJ, Kesser, BW. Malignant otitis externa. Otolaryngol Clin North Am 2008;41:537–49CrossRefGoogle ScholarPubMed
8Bernstein, JM, Holland, NJ, Porter, GC, Maw, AR. Resistance of pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa. J Laryngol Otol 2007;121:118–23CrossRefGoogle ScholarPubMed
9Hollis, S, Evans, K. Management of malignant (necrotising) otitis externa. J Laryngol Otol 2011;125:1212–17CrossRefGoogle ScholarPubMed
10Courson, AM, Vikram, HR, Barrs, DM. What are the criteria for terminating treatment for necrotizing (malignant) otitis externa? Laryngoscope 2014;124:361–2CrossRefGoogle ScholarPubMed