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Emerging themes in necrotising otitis externa: a scoping review of the literature from 2011 to 2020 and recommendations for future research

Part of: JLO Editors' Choice Papers 2022

Published online by Cambridge University Press:  20 October 2021

E Stapleton  and
G Watson
E Stapleton*
Affiliation:
Department of Otolaryngology, Manchester Royal Infirmary, UK
G Watson
Affiliation:
Department of Otolaryngology, Royal Hallamshire Hospital, Sheffield, UK
*
Author for correspondence: Dr Emma Stapleton, Department of Otolaryngology, Peter Mount Building, Manchester Royal Infirmary, Oxford Road, ManchesterM13 9WL, UK E-mail: [email protected]
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Abstract

Objective

Necrotising otitis externa is an invasive, infective condition, with minimal evidence underpinning its diagnosis and management. This work aimed to analyse literature from the past decade, to identify emerging themes and important topics for future research.

Methods

A robust literature search and review were conducted by two researchers. Sixty studies were filtered into the final review. A grounded theory approach was used to identify core themes. Data within these themes formed the basis of the review.

Results

There is no consensus regarding a clinical definition or outcome measures of necrotising otitis externa, and there exists no level 1, 2 or 3 evidence to diagnose, investigate, monitor or treat necrotising otitis externa. Emerging themes in the literature direct researchers to important topics for future clinical trials, including risk factors, microbiological culture, management strategies and radiology.

Conclusion

In order to optimise understanding and management of necrotising otitis externa, future research requires robust clinical trials and consistently reported outcome measures.

Keywords

OtitisOsteomyelitisDiabetes MellitusOtologyOtalgia
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 7 , July 2022 , pp. 575 - 581
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.

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Footnotes

Dr E Stapleton takes responsibility for the integrity of the content of the paper

References

Chandler, JR. Malignant external otitis. Laryngoscope 1968;78:1257–94CrossRefGoogle ScholarPubMed
Cohen, D, Friedman, P. The diagnostic criteria of malignant otitis externa. J Laryngol Otol 1987;101:216–19CrossRefGoogle Scholar
Mahdyoun, P, Pulcini, C, Gahide, I, Raffaelli, C, Savoldelli, C, Castillo, L et al. Necrotizing otitis externa. Otol Neurotol 2013;34:620–9CrossRefGoogle ScholarPubMed
Chawdhary, G, Liow, N, Democratis, J, Whiteside, O. Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistic trends. J Laryngol Otol 2015;129:600–3Google ScholarPubMed
Mays, N, Roberts, E, Popay, J. Synthesising research evidence. In: Fulop, N, Allen, P, Clarke, A, Black, N, eds. Studying the Organisation and Delivery of Health Services: Research Methods. London: Routledge, 2001;194Google Scholar
Arksey, H, O'Malley, L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005;8:19–3210.1080/1364557032000119616CrossRefGoogle Scholar
Patton, M. Qualitative Research and Evaluation Methods. Thousand Oaks, CA: Sage Publications, 2002Google Scholar
Sbaraini, A, Carter, SM, Wendell Evans, R, Blinkhorn, A. How to do a grounded theory study: a worked example of a study of dental practices. BMC Med Res Methodol 2001;11:12810.1186/1471-2288-11-128CrossRefGoogle Scholar
Lau, K, Scotta, G, Wu, K, Kabuli, MAK, Watson, G. A review of thirty-nine patients diagnosed with necrotising otitis externa over three years: is CT imaging for diagnosis sufficient? Clin Otol 2020;45:414–18CrossRefGoogle ScholarPubMed
Hutson, KH, Watson, GJ. Malignant otitis externa, an increasing burden in the twenty-first century: review of cases in a UK teaching hospital, with a proposed algorithm for diagnosis and management. J Laryngol Otol 2019;133:356–6210.1017/S0022215119000604CrossRefGoogle Scholar
Chawdhary, G, Pankhania, M, Douglas, S, Bottrill, I. Current management of necrotising otitis externa in the UK: survey of 221 UK otolaryngologists. Acta Otolaryngol 2017;137:818–2210.1080/00016489.2017.1295468CrossRefGoogle ScholarPubMed
Hopkins, ME, Bennett, A, Henderson, N, MacSween, KF, Baring, D, Sutherland, R. A retrospective review and multi-specialty, evidence-based guideline for the management of necrotising otitis externa. J Laryngol Otol 2020;134:487–92CrossRefGoogle ScholarPubMed
Yang, TH, Xirasagar, S, Cheng, YF, Wu, CS, Ka, Y, Shia, BC et al. Malignant otitis externa is associated with diabetes: a population-based case-control study. Ann Otol Rhinol Laryngol 2020;129:585–90CrossRefGoogle ScholarPubMed
Sylvester, MJ, Sanghvi, S, Patel, VM, Eloy, JA, Ying, YLM. Malignant otitis externa hospitalizations: analysis of patient characteristics. Laryngoscope 2016;127:2328–36CrossRefGoogle ScholarPubMed
Lambor, DV, Das, CP, Goel, HC, Tiwari, M, Lambor, SD, Fegade, MV. Necrotising otitis externa: clinical profile and management protocol. J Laryngol Otol 2013;127:1071–710.1017/S0022215113002259CrossRefGoogle ScholarPubMed
Peled, C, Parra, A, El-Saied, S, Kraus, M, Kaplan, DM. Surgery for necrotizing otitis externa - indications and surgical findings. Eur Arc Otorhinolaryngol 2020;277:1327–34CrossRefGoogle ScholarPubMed
Honnurappa, V, Ramdass, S, Mahajan, N, Vijayendra, VK, Redlea, M. Effective inexpensive management of necrotizing otitis externa is possible in resource-poor settings. Ann Otol Rhinol Laryngol 2019;128:848–54CrossRefGoogle ScholarPubMed
Lee, SK, Lee, SA, Seon, SW, Jung, JH, Lee, JD, Choi, JY et al. Analysis of prognostic factors in malignant external otitis. Clin Exp Otorhinolaryngol 2017;10:228–35CrossRefGoogle ScholarPubMed
Hobson, CE, Moy, JD, Byers, KE, Raz, Y, Hirsch, BE, McCall, AA. Malignant otitis externa. Otolaryngol Head Neck Surg 2014;151:112–16CrossRefGoogle ScholarPubMed
Soudry, E, Hamzany, Y, Preis, M, Joshua, B, Hadar, T, Nageris, BI. Malignant external otitis. Otolaryngol Head Neck Surg 2011;144:758–6210.1177/0194599810396132CrossRefGoogle ScholarPubMed
Chen, YA, Chan, KC, Chen, CK, Wu, CM. Differential diagnosis and treatments of necrotizing otitis externa: a report of 19 cases. Auris Nasus Larynx 2011;38:666–7010.1016/j.anl.2011.01.020CrossRefGoogle ScholarPubMed
Verim, A, Naiboğlu, B, Karaca, ÇT, Şeneldir, L, Külekçi, S, Oysu, Ç. Clinical outcome parameters for necrotizing otitis externa. Otol Neurotol 2014;35:371–6CrossRefGoogle ScholarPubMed
Clerc, NL, Verillaud, B, Duet, M, Guichard, JP, Herman, P, Kania, R. Skull base osteomyelitis: incidence of resistance, morbidity, and treatment strategy. Laryngoscope 2014;124:2013–16CrossRefGoogle ScholarPubMed
Pulcini, C, Mahdyoun, P, Cua, E, Gahide, I, Castillo, L, Guevara, N. Antibiotic therapy in necrotising external otitis: case series of 32 patients and review of the literature. Eur J Clin Microbiol Infect Dis 2012;31:3287–94CrossRefGoogle ScholarPubMed
Schraiber, A, Ravanelli, M, Rampinelli, V, Ferrari, M, Vural, A, Mattavelli, D et al. Skull base osteomyelitis: clinical and radiologic analysis of a rare and multifaceted pathological entity. Neurosurg Rev 2021;44:555–6910.1007/s10143-020-01254-xCrossRefGoogle Scholar
Schwam, ZG, Ferrandino, R, Kaul, VZ, Wanna, GB, Cosetti, MK. Thirty-day readmission and prolonged length of stay in malignant otitis externa. Laryngoscope 2020;130:2220–810.1002/lary.28409CrossRefGoogle ScholarPubMed
Byun, YJ, Patel, J, Nguyen, SA, Lambert, PR. Necrotizing otitis externa: a systematic review and analysis of changing trends. Otol Neurotol 2020;41:1004–11CrossRefGoogle ScholarPubMed
Peled, C, El-Seid, S, Bahat-Dinur, A, Tzvi-Ran, LR, Kraus, M, Kaplan, D. Necrotizing otitis externa—analysis of 83 cases: clinical findings and course of disease. Otol Neurotol 2019;40:56–62CrossRefGoogle ScholarPubMed
Stern Shavit, S, Bernstine, H, Sopov, V, Nageris, B, Hilly, O. FDG-PET/CT for diagnosis and follow-up of necrotizing (malignant) external otitis. Laryngoscope 2019;129:961–6CrossRefGoogle ScholarPubMed
Rozenblum-Beddok, L, Verillaud, B, Paycha, F, Vironneau, P, Abulizi, M, Benada, A. 99mTc-HMPAO-leukocyte scintigraphy for diagnosis and therapy monitoring of skull base osteomyelitis. Laryngoscope Invest Otolaryngol 2018;14:218–2410.1002/lio2.159CrossRefGoogle Scholar
Hasibi, M, Ashtiani, MK, Motassadi Zarandi, M, Yazdani, N, Borghei, P, Kuhi, A. Treatment protocol for management of bacterial and fungal malignant external otitis: a large cohort in Tehran, Iran. Ann Otol Rhinol Laryngol 2017;126:561–7CrossRefGoogle ScholarPubMed
Glikson, E, Sagiv, D, Wolf, M, Shapira, Y. Necrotizing otitis externa: diagnosis, treatment, and outcome in a case series. Diagn Microbiol Infect Dis 2017;87:74–8CrossRefGoogle ScholarPubMed
Stern Shavit, S, Soudry, E, Hamzany, Y, Nageris, B. Malignant external otitis: factors predicting patient outcomes. Am J Otolaryngol 2016;37:425–30CrossRefGoogle ScholarPubMed
Stevens, SM, Lambert, PR, Baker, A, Meyer, TA. Malignant otitis externa. Otol Neurotol 2015;36:1492–8CrossRefGoogle ScholarPubMed
Hasnaoui, M, Mabrouk, AB, Chelli, J, Ammari, FL, Lahmar, R, Toumi, A et al. Necrotising otitis externa: a single centre experience. J Otol 2021;16:22–6CrossRefGoogle ScholarPubMed
Guevara, N, Mahdyoun, P, Pulcini, C, Raffaelli, C, Gahide, I, Castillo, L. Initial management of necrotizing external otitis: errors to avoid. Eur Ann Otorhinolaryngol Head Neck Dis 2013;130:115–21CrossRefGoogle Scholar
Long, DA, Koyfman, A, Long, B. An emergency medicine-focused review of malignant otitis externa. Am J Emerg Med 2020;38:1671–810.1016/j.ajem.2020.04.083CrossRefGoogle ScholarPubMed
Van der Meer, WL, van Tilburg, M, Mitea, C, Postma, AA. A persistent foramen of Huschke: a small road to misery in necrotizing external otitis. AJNR Am J Neuroradiol 2019;40:1552–6Google ScholarPubMed
Hatch, J, Bauschard, MJ, Nguyen, SA, Lambert, PR, Meye, TA, McRackan, TR. Malignant otitis externa outcomes: a study of the university health system consortium database. Ann Otol Rhinol Laryngol 2018;127:514–2010.1177/0003489418778056CrossRefGoogle Scholar
Sharma, S, Corrah, T, Singh, A. Management of necrotizing otitis externa: our experience with forty-three patients. J Int Adv Otol 2017;13:394–8CrossRefGoogle ScholarPubMed
Karaman, E, Yilmaz, M, Ibrahimov, M, Haciyev, Y, Enver, O. Malignant otitis externa. J Craniofac Surg 2012;23:1748–51CrossRefGoogle ScholarPubMed
Loh, S, Loh, WS. Malignant otitis externa. Otolaryngol Head Neck Surg 2013;148:991–6CrossRefGoogle ScholarPubMed
Kaya, I, Sezgin, B, Eraslan, S, Ozturk, K, Gode, S, Bilgen, C et al. Malignant otitis externa: a retrospective analysis and treatment outcomes. Turk Arch Otorhinolaryngol 2018;56:106–10CrossRefGoogle ScholarPubMed
Courson, AM, Vikram, H, Barrs, DM. What are the criteria for terminating treatment for necrotizing (malignant) otitis externa? Laryngoscope 2013;124:361–2CrossRefGoogle ScholarPubMed
Arsovic, N, Radivojevic, N, Jesic, S, Babac, S, Cvorovic, L, Dudvarski, Z. Malignant otitis externa: causes for various treatment responses. J Int Adv Otol 2020;16:98–103CrossRefGoogle ScholarPubMed
Williams, SP, Curnow, TL, Almeyda, R. Lessons learnt from the diagnosis and antimicrobial management of necrotising (malignant) otitis externa: our experience in a tertiary referral centre. B-ENT 2014;10:99–104Google Scholar
Abu Eta, R, Gavriel, H, Stephen, K, Eviatar, E, Yeheskeli, E. The significance of tissue biopsy for fungi in necrotizing otitis externa. Eur Arch Otorhinolaryngol 2018;275:2941–5CrossRefGoogle ScholarPubMed
Spielmann, PM, Yu, R, Neeff, M. Skull base osteomyelitis: current microbiology and management. J Laryngol Otol 2013;127(suppl 1):S8–1210.1017/S0022215112002356CrossRefGoogle ScholarPubMed
Bhat, V, Aziz, A, Bhandary, SK, Aroor, R, Kamath, SD, Saldanha, M. Malignant otitis externa – a retrospective study of 15 patients treated in a tertiary healthcare centre. J Int Adv Otol 2015;11:72–6CrossRefGoogle Scholar
Yeheskeli, E, Eta, RA, Gavriel, H, Kleid, S, Eviatar, E. Temporomandibular joint involvement as a positive clinical prognostic factor in necrotising external otitis. J Laryngol Otol 2016;130:435–9CrossRefGoogle ScholarPubMed
Marchionni, E, Parize, P, Lefevre, A, Vironneau, P, Bougnoux, ME, Poiree, S et al. Aspergillus spp. invasive external otitis: favourable outcome with a medical approach. Clin Microbiol Infect 2016;22:434–7CrossRefGoogle ScholarPubMed
Lee, J, Song, J, Oh, S, Chang, S, Kim, C, Lee, J. Prognostic value of extension patterns on follow-up magnetic resonance imaging in patients with necrotizing otitis externa. Arch Otolaryngol Head Neck Surg 2011;137:688–93CrossRefGoogle ScholarPubMed
Chin, R, Roche, P, Sigston, E, Valance, N. Malignant otitis externa: an Australian case series. Surgeon 2012;10:273–7CrossRefGoogle ScholarPubMed
Marina, S, Gautham, MK, Rajeshwary, A, Vadisha, B, Devika, T. A retrospective review of 14 cases of malignant otitis externa. J Otol 2019;14:63–6CrossRefGoogle ScholarPubMed
Bhasker, D, Hartley, A, Agada, F. Is malignant otitis externa on the increase? A retrospective review of cases. Ear Nose Throat J 2017;96:E1–5CrossRefGoogle ScholarPubMed
Berenholz, L, Katzenell, U, Harell, M. Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa. Laryngoscope 2002;112:1619–22CrossRefGoogle ScholarPubMed
Pankhania, M, Bashyam, A, Judd, O, Jassar, P. Antibiotic prescribing trends in necrotising otitis externa: a survey of 85 trusts in the United Kingdom: our experience. Clin Otolaryngol 2016;41:293–6CrossRefGoogle ScholarPubMed
Balakrishnan, R, Dalakoti, P, Nayak, DR, Pujary, K, Singh, R, Kumar, R. Efficacy of HRCT imaging vs SPECT/CT scans in the staging of malignant external otitis. Otolaryngol Head Neck Surg 2019;161:336–42CrossRefGoogle ScholarPubMed
Omran, AA, El Garem, HF, Al Alem, RK. Recurrent malignant otitis externa: management and outcome. Eur Arch Otorhinolaryngol 2011;269:807–11CrossRefGoogle ScholarPubMed
Amaro, CE, Espiney, R, Radu, L, Guerreiro, F. Malignant (necrotizing) externa otitis: the experience of a single hyperbaric centre. Eur Arch Otorhinolaryngol 2019;276:1881–7CrossRefGoogle ScholarPubMed
Vion, P, Verillaud, B, Paycha, F, Benada, A, El-Deeb, G, Herman, P et al. 99mTc-HMPAO-leukocyte scintigraphy and [18F]FDG-PET/CT for diagnosis and therapy monitoring in eleven patients with skull base osteomyelitis. Clin Otol 2020;45:591–4CrossRefGoogle Scholar
Kuczkowski, J, Nowicki, TK. Indications for surgery in necrotizing otitis externa. Eur Arch Otorhinolaryngol 2020. Epub 2020 Jun 1Google ScholarPubMed
Cooper, T, Hildrew, D, McAfee, JS, McCall, AA, Branstetter, BF 4th, Hirsch, BE. Imaging in the diagnosis and management of necrotizing otitis externa: a series of practice patterns. Otol Neurotol 2018;39:597–601CrossRefGoogle Scholar
Sturm, JJ, Stern Shavit, S, Lalwani, AK. What is the best test for diagnosis and monitoring treatment response in malignant otitis externa? Laryngoscope 2020;130:2516–17CrossRefGoogle ScholarPubMed
Van Kroonenburgh, AMJL, van der Meer, WL, Bothof, RJP, van Tilburg, M, van Tongeren, J, Postma, AA. Advanced imaging techniques in skull base osteomyelitis due to malignant otitis externa. Curr Radiol Rep 2018;6:3CrossRefGoogle ScholarPubMed
Kulkarni, SC, Padma, S, Shanmuga Sundaram, P. In the evaluation of patients with skull base osteomyelitis, does 18F-FDG PET CT have a role? Nucl Med Commun 2020;41:550–9CrossRefGoogle ScholarPubMed