title: Initial management of necrotizing external otitis: errors to avoid.
abstract: OBJECTIVE
  Diagnostic and therapeutic practice guidelines have been established for classical forms of benign otitis externa. However, these guidelines do not include unusual forms of the disease, especially "invasive" otitis externa. No consensual diagnostic flow diagram has been published in the literature, which frequently results in delayed diagnosis and inappropriate primary care management. The objective of this study was to analyse the primary care management practices of malignant otitis externa (MOE).
  
  
  METHODS
  Retrospective study of 22 cases of MOE managed in our tertiary care centre over a 6-year period (2004-2010).
  
  
  RESULTS
  All but one of the patients presented a systemic or local predisposing factor. The mean interval between onset of the first symptoms and referral to our tertiary care centre was 13weeks (range: 1 to 12months); 77% of patients were referred by a private ENT specialist, 14% were referred by a an emergency department and 9% were referred by a hospital department. Seventeen patients (81%) had received one or more courses of inappropriate systemic antibiotics during this interval (oral in 15 cases, parenteral in two cases, multiple treatments in 13 cases). The mean duration of each course of antibiotics was 12days (range: 7 to 21days). All patients also received local antibiotic ear drops (aminoglycosides or fluoroquinolones).
  
  
  CONCLUSIONS
  The practice audit constantly revealed delayed management of MOE, often resulting in inappropriate antibiotic prescriptions. Publication of practice guidelines for primary and secondary care practitioners therefore appears to be essential.
authors.affiliation: Groupement de coopération sanitaire, centre Antoine-Lacassagne, institut universitaire de la face et du cou, centre hospitalier universitaire de Nice, 31, avenue de Valombrose, 06107 Nice cedex 2, France. guevara.n@chu-nice.fr
authors.forename: N
authors.initials: N
authors.lastname: Guevara
authors.forename: P
authors.initials: P
authors.lastname: Mahdyoun
authors.forename: C
authors.initials: C
authors.lastname: Pulcini
authors.forename: C
authors.initials: C
authors.lastname: Raffaelli
authors.forename: I
authors.initials: I
authors.lastname: Gahide
authors.forename: L
authors.initials: L
authors.lastname: Castillo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D002442:Ceftazidime / Q000008:administration & dosage; D002939:Ciprofloxacin / Q000008:administration & dosage; D057210:Delayed Diagnosis; D004359:Drug Therapy, Combination; D005260:Female; D006785:Hospitals, University; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D008297:Male; D008485:Medical Audit; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009336:Necrosis; D010032:Otitis Externa / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology*; D010818:Practice Patterns, Physicians'; D011552:Pseudomonas Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D002939:Ciprofloxacin; D002442:Ceftazidime