title: Optimised diagnosis and treatment of necrotizing external otitis is warranted.
abstract: BACKGROUND
  Necrotizing external otitis (NEO) is a devastating and life-threatening infection in the external auditory canal and the temporal bone. The aim of this paper is to evaluate the diagnostics and treatment of NEO and to recommend new guidelines.
  
  
  METHODS
  Eleven patients were retrospectively enrolled under the code DH609 otitis externa without specification from 1 January 2000 to 31 December 2009. Records were reviewed to register: age, symptoms, clinical findings, comorbidity, imaging, microbiology and treatment.
  
  
  RESULTS
  The median age was 75 years and the median time of therapy at the hospital was 6.3 months. All patients belonged to a risk group. A diagnostic delay was found resulting in further progression of the disease. In contrast to current international recommendations, the treatment consisted mostly of local antibiotics in combination with surgery. All patients survived, but most patients were left with hearing loss and psychiatric problems.
  
  
  CONCLUSIONS
  A greater awareness of diagnostic criteria and a shift from local antibiotics to prolonged systemic monotherapy with ciprofloxacin in accordance with international concepts is recommended. Surgery should be left for extensive and refractory cases only. A list of diagnostic criteria and treatment guidelines is presented.
  
  
  BACKGROUND
  Not relevant.
  
  
  BACKGROUND
  Not relevant.
authors: Department of Otorhino-laryngology, Head and Neck Surgery, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
authors: Kirse
authors: K
authors: Bock
authors: Therese
authors: T
authors: Ovesen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002097:C-Reactive Protein; D002939:Ciprofloxacin / Q000627:therapeutic use; D018450:Disease Progression; D004424:Ear Canal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy; D010032:Otitis Externa / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013701:Temporal Bone
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D002097:C-Reactive Protein