Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-22T21:54:30.831Z Has data issue: false hasContentIssue false
  • English
  • Français

Exploring theories for the exponential 16-year rise in incidence of necrotising otitis externa in England

Published online by Cambridge University Press:  10 January 2022

S Linton  and
E Stapleton Open the ORCID record for E Stapleton [Opens in a new window]
S Linton
Affiliation:
Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
E Stapleton*
Affiliation:
Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
*
Author for correspondence: Dr Emma Stapleton, Department of Otolaryngology, Peter Mount Building, Manchester Royal Infirmary, Oxford Road, ManchesterM13 9WL, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Necrotising otitis externa is a severe, life-threatening infection. Epidemiological data demonstrate a dramatic rise in reported cases in England from 2002 to 2017. The reasons for this remain elusive.

Methods

A quantitative descriptive study was undertaken using epidemiological data from the Hospital Episode Statistics database. Cases from 2002 to 2017 were compiled and analysed. Four potential theories were explored to explain the rise in incidence.

Results

Within the 16-year period, 7327 necrotising otitis externa cases were reported. Annual necrotising otitis externa incidence increased 1142 per cent within the 16-year period, from 123 recorded cases in 2002 to 1405 cases in 2017. This correlates with an increasing prevalence of diabetes, an ageing population and likely increased physician awareness of necrotising otitis externa. There is insufficient evidence to support antibiotic resistance as a significant associated factor.

Conclusion

Correlation does not imply causation. It is likely that a combination of factors is contributing to the rise in necrotising otitis externa incidence, including increased physician recognition, diagnosis and accurate clinical coding.

Keywords

Otitis ExternaOsteomyelitisDiabetes MellitusImmunosuppression
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 10 , October 2022 , pp. 925 - 929
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr E Stapleton takes responsibility for the integrity of the content of the paper

This paper was presented (and awarded the North of England Otolaryngology Society Prize for best trainee presentation) at the North of England Otolaryngology Society Autumn meeting, 23 October 2019, Wakefield, UK.

References

Chandler, J. Malignant external otitis. Laryngoscope 1968;78:1257–94CrossRefGoogle ScholarPubMed
Meltzer, PE, Kelemen, G. Pyocyaneous osteomyelitis of the temporal bone, mandible and zygoma. Laryngoscope 1959;69:1300–16CrossRefGoogle Scholar
Chawdhary, G, Liow, N, Democratis, J, Whiteside, O. Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistic trends. J Laryngol Otol 2015;129:600–3CrossRefGoogle Scholar
Lau, K, Scotta, G, Wu, K, Kabuli, MAK, Watson, G. A review of thirty-nine patients diagnosed with necrotising otitis externa over three years: is CT imaging for diagnosis sufficient? Clin Otolaryngol 2020;45:414–18CrossRefGoogle ScholarPubMed
Hutson, KH, Watson, GJ. Malignant otitis externa, an increasing burden in the twenty-first century: review of cases in a UK teaching hospital, with a proposed algorithm for diagnosis and management. J Laryngol Otol 2019;133:356–62CrossRefGoogle Scholar
Chawdhary, G, Pankhania, M, Douglas, S, Bottrill, I. Current management of necrotising otitis externa in the UK: survey of 221 UK otolaryngologists. Acta Otolaryngol 2017;137:818–22CrossRefGoogle ScholarPubMed
Hopkins, ME, Bennett, A, Henderson, N, MacSween, KF, Baring, D, Sutherland, R. A retrospective review and multi-specialty, evidence-based guideline for the management of necrotising otitis externa. J Laryngol Otol 2020;134:487–92CrossRefGoogle ScholarPubMed
Yang, TH, Xirasagar, S, Cheng, YF, Wu, CS, Ka, Y, Shia, BC et al. Malignant otitis externa is associated with diabetes: a population-based case-control study. Ann Otol Rhinol Laryngol 2020;129:585–90CrossRefGoogle ScholarPubMed
Sylvester, MJ, Sanghvi, S, Patel, VM, Eloy, JA, Ying, YLM. Malignant otitis externa hospitalizations: analysis of patient characteristics. Laryngoscope 2016;127:2328–36CrossRefGoogle ScholarPubMed
Stern, Shavit S, Soudry, E, Hamzany, Y, Nageris, B. Malignant external otitis: factors predicting patient outcomes. Am J Otolaryngol 2016;37:425–30CrossRefGoogle Scholar
Carlton, D, Perez, E, Smouha, E. Malignant external otitis: the shifting treatment paradigm. Am J Otolaryngol 2018;39:41–5CrossRefGoogle ScholarPubMed
Chin, R, Roche, P, Sigston, E, Valance, N. Malignant otitis externa: an Australian case series. Surgeon 2012;10:273–7CrossRefGoogle ScholarPubMed
Ali, T, Meade, K, Anari, S, ElBadawey, M, Zammit-Maempel, I. Malignant otitis externa: case series. J Laryngol Otol 2010;124:846–51CrossRefGoogle ScholarPubMed
Marhoffer, W, Stein, M, Maeser, E, Federlin, K. Impairment of polymorphonuclear leukocyte function and metabolic control of diabetes. Diabetes Care 1992;15:256–60CrossRefGoogle ScholarPubMed
Marhoffer, W, Stein, M, Schleinkofer, L, Federlin, K. Evidence of ex vivo and in vitro impaired neutrophil oxidative burst and phagocytic capacity in type 1 diabetes mellitus. Diabetes Res Clin Pract 1993;19:183–8CrossRefGoogle ScholarPubMed
Gallacher, S, Thomson, G, Fraser, W, Fisher, B, Gemmell, C, MacCuish, A. Neutrophil bactericidal function in diabetes mellitus: evidence for association with blood glucose control. Diabet Med 1995;12:916–20Google ScholarPubMed
Driscoll, P, Ramachandrula, A, Drezner, D, Hicks, T, Schaffer, S. Characteristics of cerumen in diabetic patients: a key to understanding malignant external otitis? Otolaryngol Head Neck Surg 1993;109:676–9CrossRefGoogle ScholarPubMed
Mahdyoun, P, Pulcini, C, Gahide, I, Raffaelli, C, Savoldelli, C, Castillo, L et al. Necrotizing otitis externa. Otol Neurotol 2013;34:620–9CrossRefGoogle ScholarPubMed
Loh, S, Loh, WS. Malignant otitis externa. Otolaryngol Head Neck Surg 2013;148:991–6CrossRefGoogle ScholarPubMed
Berenholz, L, Katzenell, U, Harell, M. Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa. Laryngoscope 2002;112:1619–22Google ScholarPubMed
Hobson, CE, Moy, JD, Byers, KE, Raz, Y, Hirsch, BE, McCall, AA. Malignant otitis externa. Otolaryngol Head Neck Surg 2014;151:112–16CrossRefGoogle ScholarPubMed
Clerc, NL, Verillaud, B, Duet, M, Guichard, JP, Herman, P, Kania, R. Skull base osteomyelitis: incidence of resistance, morbidity, and treatment strategy. Laryngoscope 2014;124:2013–16CrossRefGoogle ScholarPubMed
Marchionni, E, Parize, P, Lefevre, A, Vironneau, P, Bougnoux, ME, Poiree, S et al. Aspergillus spp. invasive external otitis: favourable outcome with a medical approach. Clin Microbiol Infect 2016;22:434–7CrossRefGoogle ScholarPubMed
Hooper, D. Mechanisms of fluoroquinolone resistance. Drug Resist Updat 1999;2:38–55CrossRefGoogle ScholarPubMed
Lew, D, Waldvogel, F. Quinolones and osteomyelitis. Drugs 1995;49:100–11Google ScholarPubMed
Bernstein, J, Holland, N, Porter, G, Maw, A. Resistance of Pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa. J Laryngol Otol 2006;121:118–23CrossRefGoogle ScholarPubMed
Rehman, A, Patrick, W, Lamont, I. Mechanisms of ciprofloxacin resistance in Pseudomonas aeruginosa: new approaches to an old problem. J Med Microbiol 2019;68:1–10CrossRefGoogle Scholar
Li, X, Nikaido, H, Poole, K. Role of mexA-mexB-oprM in antibiotic efflux in Pseudomonas aeruginosa. Antimicrob Agents Chemother 1995;39:1948–53CrossRefGoogle ScholarPubMed
UK Data Service. Census. In: https://census.ukdataservice.ac.uk/ [28 June 2020]Google Scholar
Weyand, C, Goronzy, J. Aging of the immune system. Mechanisms and therapeutic targets. Ann Am Thorac Soc 2016;13:S422–8CrossRefGoogle ScholarPubMed
Corberand, J, Ngyen, F, Laharrague, P, Fontanilles, A, Gleyzes, B, Gyrard, E et al. Polymorphonuclear functions and aging in humans. J Am Geriatr Soc 1981;29:391–7CrossRefGoogle ScholarPubMed