title: Necrotizing otitis externa: a systematic review.
abstract: OBJECTIVE
  To carry out a systematic review of scientific evidence available about necrotizing otitis externa, emphasizing epidemiologic data, diagnosis criteria, treatment protocols, follow-up criteria, prognosis factors, and chronologic evolution.
  
  
  METHODS
  PubMed/MEDLINE and the Cochrane Database of Systematic Reviews were searched for publications in English and French languages, between 1968 and October 1, 2011.
  
  
  METHODS
  We included publications of all types including at least 6 cases. We excluded publications focused on cranial base osteomyelitis not originating from the external ear and publications limited to a specific population.
  
  
  METHODS
  We assessed publication quality according to international guidelines.
  
  
  RESULTS
  For each publication, data were entered in a spreadsheet software for analysis. We excluded individual data already published in other studies or reviews.
  
  
  CONCLUSIONS
  Our review revealed the absence of strong scientific evidence regarding diagnosis criteria, treatment protocols and follow-up criteria. This implies the use of highly empirical indexes of suspicion in clinical practice. Our review confirmed the existence of a typical but not exclusive population at risk (aged, male, and diabetic patient) and also revealed major issues: lack of primary prevention in population at risk, delays before referral and management, bacteriologic issues caused by antibiotic misuse (agent identification problems, rise of resistant strains), persistence of recurrent cases. A better diffusion of medical information should help improve the management of this severe disease.
authors.affiliation: Institut Universitaire de la Face et du Cou, Head and Neck Department-Nice University Hospital, Nice, France.
authors.forename: Pouya
authors.initials: P
authors.lastname: Mahdyoun
authors.forename: Céline
authors.initials: C
authors.lastname: Pulcini
authors.forename: Ivan
authors.initials: I
authors.lastname: Gahide
authors.forename: Charles
authors.initials: C
authors.lastname: Raffaelli
authors.forename: Charles
authors.initials: C
authors.lastname: Savoldelli
authors.forename: Laurent
authors.initials: L
authors.lastname: Castillo
authors.forename: Nicolas
authors.initials: N
authors.lastname: Guevara
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006801:Humans; D009336:Necrosis / Q000188:drug therapy / Q000473:pathology; D010032:Otitis Externa / Q000188:drug therapy / Q000473:pathology*
chemical_list: D000900:Anti-Bacterial Agents