Necrotizing otitis externa

7 Interesting Facts of Necrotizing otitis externa

  1. Rare, aggressive, severe infection of the external auditory canal, surrounding support structures, and bone (eg, mastoid, temporal bone); over 90% of cases are caused by Pseudomonas 
  2. Many experts regard necrotizing otitis externa as a complication of untreated otitis externa; necrotizing otitis externa may represent a unique, rapidly invasive infectious process and separate pathophysiologic entity from acute otitis externa
  3. Almost exclusively occurs in adult patients (primarily in elderly people) and patients with immunocompromise (eg, diabetes, HIV); over 90% of patients who develop necrotizing otitis externa have diabetes 
  4. Early in the necrotizing otitis externa disease process, patients can present with similar, but more intense, symptoms (eg, otalgia, otorrhea) as patients with acute otitis externa
  5. Eventually, patients will develop high fever, malaise, severe pain out of proportion to examination findings, and granulation tissue along the floor of the external auditory canal; may develop cranial nerve palsies, vertigo, and meningeal signs
  6. Fever and malaise do not occur with otitis externa; differentiate diseases by clinical presentation, disease course, and imaging
  7. Confirm necrotizing otitis externa by imaging; CT identifies extension of infection outside of the external auditory canal (eg, bony erosion, soft tissue involvement); MRI better characterizes soft tissue abnormalities and identifies retrocondylar fat infiltration, a finding present in 93% of patients with necrotizing otitis externa

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