TY - JOUR
T1 - Systematic review of the diagnosis and management of necrotising otitis externa
T2 - Highlighting the need for high-quality research
AU - Takata, Junko
AU - Hopkins, Michael
AU - Alexander, Victoria
AU - Bannister, Oliver
AU - Dalton, Lucy
AU - Harrison, Laura
AU - Groves, Emily
AU - Kanona, Hala
AU - Jones, Gwennan Llwyd
AU - Mohammed, Hassan
AU - Andersson, Monique I.
AU - Hodgson, Susanne H.
N1 - Funding Information:
Many thanks to Liz Callow and Elinor Harriss from the Bodleian Health Care Libraries, University of Oxford for performing the literature searches.
Publisher Copyright:
© 2023 The Authors. Clinical Otolaryngology published by John Wiley & Sons Ltd.
PY - 2023/5
Y1 - 2023/5
N2 - Objectives: To present a systematic review and critical analysis of clinical studies for necrotising otitis externa (NOE), with the aim of informing best practice for diagnosis and management. Design: Medline, Embase, Cochrane Library and Web of Science were searched from database inception until 30 April 2021 for all clinical articles on NOE. The review was registered on PROSPERO (ID: CRD42020128957) and conducted in accordance with PRISMA guidelines. Results: Seventy articles, including 2274 patients were included in the final synthesis. Seventy-three percent were retrospective case series; the remainder were of low methodological quality. Case definitions varied widely. Median patient age was 69.2 years; 68% were male, 84% had diabetes and 10% had no reported immunosuppressive risk factor. Otalgia was almost universal (96%), with granulation (69%) and oedema (76%) the commonest signs reported. Pseudomonas aeruginosa was isolated in 62%, but a range of bacterial and fungal pathogens were reported and 14% grew no organism. Optimal imaging modality for diagnosis or follow-up was unclear. Median antimicrobial therapy duration was 7.2 weeks, with no definitive evidence for optimal regimens. Twenty-one percent had surgery with widely variable timing, indication, or procedure. One-year disease-specific mortality was 2%; treatment failure and relapse rates were 22% and 7%, respectively. Conclusion: There is a lack of robust, high-quality data to support best practice for diagnosis and management for this neglected condition. A minimum set of reporting requirements is proposed for future studies. A consensus case definition is urgently needed to facilitate high-quality research.
AB - Objectives: To present a systematic review and critical analysis of clinical studies for necrotising otitis externa (NOE), with the aim of informing best practice for diagnosis and management. Design: Medline, Embase, Cochrane Library and Web of Science were searched from database inception until 30 April 2021 for all clinical articles on NOE. The review was registered on PROSPERO (ID: CRD42020128957) and conducted in accordance with PRISMA guidelines. Results: Seventy articles, including 2274 patients were included in the final synthesis. Seventy-three percent were retrospective case series; the remainder were of low methodological quality. Case definitions varied widely. Median patient age was 69.2 years; 68% were male, 84% had diabetes and 10% had no reported immunosuppressive risk factor. Otalgia was almost universal (96%), with granulation (69%) and oedema (76%) the commonest signs reported. Pseudomonas aeruginosa was isolated in 62%, but a range of bacterial and fungal pathogens were reported and 14% grew no organism. Optimal imaging modality for diagnosis or follow-up was unclear. Median antimicrobial therapy duration was 7.2 weeks, with no definitive evidence for optimal regimens. Twenty-one percent had surgery with widely variable timing, indication, or procedure. One-year disease-specific mortality was 2%; treatment failure and relapse rates were 22% and 7%, respectively. Conclusion: There is a lack of robust, high-quality data to support best practice for diagnosis and management for this neglected condition. A minimum set of reporting requirements is proposed for future studies. A consensus case definition is urgently needed to facilitate high-quality research.
KW - malignant otitis externa
KW - necrotising otitis externa
KW - Pseudomonas aeruginosa
KW - skull base osteomyelitis
UR - http://www.scopus.com/inward/record.url?scp=85148594341&partnerID=8YFLogxK
U2 - 10.1111/coa.14041
DO - 10.1111/coa.14041
M3 - Review article
C2 - 36759416
AN - SCOPUS:85148594341
SN - 1749-4478
VL - 48
SP - 381
EP - 394
JO - Clinical Otolaryngology
JF - Clinical Otolaryngology
IS - 3
ER -
