Necrotizing external otitis: a report of 46 cases.
OBJECTIVE
To define germs involved, clinical presentation, treatment regimen, and prognostic factors in necrotizing external otitis.


METHODS
Retrospective study reviewing a series of 46 patients treated during 10 years in a tertiary care center. Diagnosis was confirmed by using otomicroscopy, computed tomographic and/or magnetic resonance imaging scan and bone scintigraphy (Te 99 and Ga 26 bone scan). Patients were provided ceftazidime and ciprofloxacin intravenously and monitored using a Ga-67 bone scan. The following were assessed: presenting symptoms, general context, bacteriological analysis, imaging protocol sensitivity, complications, delay to healing, and cure rate.


RESULTS
Sex ratio was 2.29 (mean age, 73.6 yr). The most common presenting symptoms were otalgia and otorrhea in 97.8 and 91.3%, respectively. Facial paralysis was present in 19.6% of cases. Thirty patients had diabetes mellitus (65.2%), and 8 were immunocompromised (17.4%). Pseudomonas aeruginosa was isolated in 69.2% of cases and was resistant to ciprofloxacin in 18.5%, but was susceptible to ceftazidime in all cases. Four patients died during the treatment (4.4%), but only 2 of disease. The mean delay to healing was 14 weeks (SD, 9.7). Healing rate was 95.6%. No relapse was observed after a mean follow-up of 78.4 weeks (SD, 36.5 wks). Two factors significantly influenced the prognosis: facial paralysis and existence of systemic factors for immune deficiency (p = 0.023 and 0.038, respectively).


CONCLUSIONS
The association of ciprofloxacin and ceftazidime was efficient in countering the increasing resistance of P. aeruginosa to quinolones. We propose a prognostic classification of necrotizing external otitis based on the presence of facial paralysis and/or systemic factors.
Franco-Vidal
Valerie
V
Otolaryngology and Skull Base Surgery Department, Pellegrin Hospital, France. valerie.vidal@chu-bordeaux.fr
Blanchet
Harold
H
Bebear
Cécile
C
Dutronc
Hervé
H
Darrouzet
Vincent
V
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D048909:Diabetes Complications; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D015242:Ofloxacin / Q000627:therapeutic use; D010032:Otitis Externa / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology*; D049268:Positron-Emission Tomography; D011379:Prognosis; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012189:Retrospective Studies; D013492:Suppuration / Q000382:microbiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D015242:Ofloxacin