title: Malignant external otitis in Spain.
abstract: BACKGROUND
  Malignant external otitis is a necrotizing infection, which extends from the squamous epithelium of the ear canal to the adjacent tissue. The objective of the study was to investigate its incidence and other epidemiological data in Spain, reporting the largest case series to date.
  
  
  METHODS
  A descriptive, retrospective study of the Spanish population was carried out using the minimum basic data set (MBDS) based on data of patients admitted to hospitals in the 2008-2013 period. Patients whose diagnosis (principal or secondary) at discharge was encoded as 380.14 (malignant external otitis), according to ICD-9-CM, were included as cases. The Spanish incidence rate was calculated for all its communities and provinces, as well as by season and mortality.
  
  
  RESULTS
  A total of 355 patients (302 as principal diagnosis and 53 as secondary) were diagnosed. The incidence rate was 1.30 (95% CI, 1.17 to 1.44) per 106 inhabitants and year, although there were variations among geographical areas. The median age of cases with main diagnosis was 74 years (range 10-95 years). The predominant age group was in patients over 84 years old (19.3 cases per 106inhabitants and year). The incidence was higher in men and the male-female relative risk was 2.4. Diabetes was present in 74.6% of patients. The diagnosis was predominant in the last quarter of the year. The gross in-hospital mortality rate was 3.7%.
  
  
  CONCLUSIONS
  Malignant external otitis is seen mostly among male elderly and diabetic patients. The incidence and mortality rate are low in Spain.
authors.affiliation: Investigación y Docencia, Hospital Universitario de La Ribera, Alzira, Valencia, España; Facultad de Medicina, Universidad Católica de Valencia, Valencia, España. Electronic address: antonioguerrero@gmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Guerrero-Espejo
authors.affiliation: Investigación y Docencia, Hospital Universitario de La Ribera, Alzira, Valencia, España.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Valenciano-Moreno
authors.affiliation: Servicio de Otorrinolaringología Hospital Universitario de La Ribera, Alzira, Valencia, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ramírez-Llorens
authors.affiliation: Servicio de Otorrinolaringología Hospital Universitario de La Ribera, Alzira, Valencia, España.
authors.forename: Palmira
authors.initials: P
authors.lastname: Pérez-Monteagudo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007674:Kidney Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D010032:Otitis Externa / Q000191:economics / Q000453:epidemiology*; D012189:Retrospective Studies; D012306:Risk; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
keywords: Aged, 80 and over; Clasificación internacional de enfermedades; Diabetes mellitus; Edad superior a los 80 años; España; Factores de riesgo; Incidence; Incidencia; International classification of diseases; Maligna; Malignant; Mortalidad; Mortality; Osteomielitis; Osteomyelitis; Otitis externa; Risk factors; Spain