title: Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistics trends.
abstract: BACKGROUND
  Necrotising (malignant) otitis externa is a severe infection causing temporal bone osteomyelitis. Although rare, our experience (reported herein) shows local doubling of cases in 2013. Hospital Episodes Statistics data for England over 14 years also indicate increased incidence nationally. Specific learning points in management are also discussed.
  
  
  METHODS
  A retrospective review was conducted of patients admitted in 2013 to Wexham Park Hospital, Slough, UK (catchment population, 450 000). In addition, the UK Government Hospital Episodes Statistics data were interrogated.
  
  
  RESULTS
  There were five cases of necrotising (malignant) otitis externa in 2013, representing a local doubling on previous years. The mean age of patients was 82 years. All cultures grew Pseudomonas aeruginosa; no isolates were antibiotic resistant. All patients responded to systemic anti-pseudomonals on clinical, biochemical and radiological parameters. Hospital Episodes Statistics data showed a six-fold increase in the number of cases from 1999 (n = 67) to 2013 (n = 421).
  
  
  CONCLUSIONS
  Our experience suggests increasing necrotising (malignant) otitis externa incidence, and retrospective analysis of Hospital Episodes Statistics data supports this observation. Necrotising (malignant) otitis externa poses challenges in management, as exemplified in our cases, requiring a high index of suspicion and early aggressive treatment to achieve cure.
authors.affiliation: Department of ENT,Wexham Park Hospital,Slough,UK.
authors.forename: G
authors.initials: G
authors.lastname: Chawdhary
authors.affiliation: Department of Microbiology,Wexham Park Hospital,Slough,UK.
authors.forename: N
authors.initials: N
authors.lastname: Liow
authors.affiliation: Department of Microbiology,Wexham Park Hospital,Slough,UK.
authors.forename: J
authors.initials: J
authors.lastname: Democratis
authors.affiliation: Department of ENT,Wexham Park Hospital,Slough,UK.
authors.forename: O
authors.initials: O
authors.lastname: Whiteside
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009336:Necrosis; D010032:Otitis Externa / Q000453:epidemiology*; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
keywords: Epidemiology; Incidence; Osteomyelitis; Otitis Externa; Pseudomonas aeruginosa; Temporal Bone