Initial management of necrotizing external otitis: Errors to avoid

Objectives: Diagnostic and therapeutic practice guidelines have been established for classical forms of benign otitis externa. However, these guidelines do not include unusual forms of the disease, especially "invasive" otitis externa. No consensual diagnostic flow diagram has been published in the literature, which frequently results in delayed diagnosis and inappropriate primary care management. The objective of this study was to analyse the primary care management practices of malignant otitis externa (MOE). Material and methods: Retrospective study of 22 cases of MOE managed in our tertiary care centre over a 6-year period (2004-2010). Results: All but one of the patients presented a systemic or local predisposing factor. The mean interval between onset of the first symptoms and referral to our tertiary care centre was 13 weeks (range: 1 to 12 months); 77% of patients were referred by a private ENT specialist, 14% were referred by a an emergency department and 9% were referred by a hospital department. Seventeen patients (81%) had received one or more courses of inappropriate systemic antibiotics during this interval (oral in 15 cases, parenteral in two cases, multiple treatments in 13 cases). The mean duration of each course of antibiotics was 12 days (range: 7 to 21 days). All patients also received local antibiotic ear drops (aminoglycosides or fluoroquinolones). Conclusions: The practice audit constantly revealed delayed management of MOE, often resulting in inappropriate antibiotic prescriptions. Publication of practice guidelines for primary and secondary care practitioners therefore appears to be essential. (C) 2012 Elsevier Masson SAS. All rights reserved.