title: Differential diagnosis and treatments of necrotizing otitis externa: a report of 19 cases.
abstract: OBJECTIVE
  Necrotizing otitis externa is an uncommon but potentially life-threatening infection disease of the external auditory canal and temporal bone. Its presentation and natural course had been largely altered through the years. The aim of this study was to analyze the clinical presentation, bacteriology, and treatment protocol and we compare those with the literature.
  
  
  METHODS
  A retrospective review of the archives of a tertiary referral center otolaryngology department (1995-2010) identified 19 cases of necrotizing otitis externa. The patient's epidemiologic, clinical, diagnostic and treatment data were evaluated.
  
  
  RESULTS
  A total of 19 patients were collected. Their mean age was 67.3 (SD, 12.2 year; range, 38-83 year). Of them, fourteen patients had diabetes mellitus (82.3%). The facial nerve was involved in 26% of the patients. Culture isolated Pseudomonas aeruginosa in 26.7% of cases, and half of them were resistant to ciprofloxacin. Five patients (26.3%) had temporomandibular area involvement. Eight patients received surgical intervention and all of them survived in the end of treatment course. The mean duration of hospitalization of was 25.8 ± 20.5 days (8-90). Two patients died during hospitalization, both from comorbidities (one from severe GI bleeding and another from septic shock).
  
  
  CONCLUSIONS
  The proportion of patients with facial palsy and diabetes in our series was comparable to those reported in the literature. But the incidence of P. aeruginosa was much lower and the rate of resistance to ciprofloxacin was high, which was supposed to result from the popularity and previous use of the quinolone ear drops before referral. And the leading cause of mortality is patient's comorbidities. Treating necrotizing otitis externa remains a great challenge even in nowadays with modern image modalities and advanced antibiotics. Physicians should have a high index of suspicion when facing patients at risk with refractory external ear infection so as to give them timely diagnosis and optimal treatment.
authors.affiliation: Department of Otolaryngology, Chang-Gung Memorial Hospital, No. 5 Fu-Shing street, Kwei-Shan Hsiang, Tao-Yuan Hsien, Taiwan.
authors.forename: Yen-An
authors.initials: YA
authors.lastname: Chen
authors.forename: Kai-Chieh
authors.initials: KC
authors.lastname: Chan
authors.forename: Chin-Kuo
authors.initials: CK
authors.lastname: Chen
authors.forename: Che-Ming
authors.initials: CM
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002939:Ciprofloxacin / Q000494:pharmacology; D015897:Comorbidity; D048909:Diabetes Complications; D003937:Diagnosis, Differential; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010032:Otitis Externa / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D011552:Pseudomonas Infections; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: D002939:Ciprofloxacin