Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-23T03:45:46.940Z Has data issue: false hasContentIssue false

Necrotising otitis externa: the increasing financial burden on the National Health Service

Published online by Cambridge University Press:  10 November 2021

J Godbehere
Affiliation:
Department of Otolaryngology Head and Neck Surgery, The Rotherham NHS Foundation Trust, Rotherham, UK
K H Hutson
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
G J Watson*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
*
Author for correspondence: Mr G J Watson, Department of ENT, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Glossop Road, SheffieldS10 2JF, UK E-mail: [email protected]

Abstract

Objective

Necrotising otitis externa is increasingly being seen and treated within the UK. The aim of this study was to explore the potential cost of a cohort of patients with necrotising otitis externa presenting to a single tertiary NHS trust.

Method

This was a retrospective study with data from 14 patients with confirmed necrotising otitis externa who were treated, monitored, discharged or who died between October 2016 and November 2018. Direct costs using the tariffs from the 2018 to 2019 financial year included in-patient stay, imaging, peripheral inserted central catheter line cost, ENT and out-patient parenteral antibiotic therapy visits and antimicrobial duration.

Results

The mean cost of treatment per patient was £17 615 (range, £9407 to £38 230) with an extreme outlier costing more than £122 000.

Conclusion

Awareness and education at a primary care level and research into robust imaging to aid termination of treatment may lower costs in the future by catching pathology early and reducing treatment duration.

Type
Main Article
Copyright
Copyright © The Author(s), 2021. 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

Mr G J Watson takes responsibility for the integrity of the content of the paper

References

Chandler, JR. Malignant otitis externa. Laryngoscope 1968;78:1257–9410.1288/00005537-196808000-00002CrossRefGoogle 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 statistics trends. J Laryngol Otol 2015;129:600–310.1017/S002221511500105XCrossRefGoogle ScholarPubMed
Hollis, S, Evans, K. Management of malignant (necrotising) otitis externa. J Laryngol Otol 2011;125:1212–1710.1017/S0022215110002550CrossRefGoogle ScholarPubMed
Chawdhary, G, Pankhania, M, Douglas, S, Bottrill, I. Current management of necrotising otitis externa in the UK: survey of 221 UK otolaryngologists. Acta Oto-Laryngolica 2017;137:818–2210.1080/00016489.2017.1295468CrossRefGoogle ScholarPubMed
Mahdyoun, P, Pulcini, C, Gahide, I, Raffaelli, C, Savoldelli, C, Castillo, L et al. Necrotizing otitis externa: a systematic review. Otol Neurotol 2013;34:620–29CrossRefGoogle 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
Courson, AM, Vikram, HR, Barrs, DM. What are the criteria for terminating treatment for necrotizing (malignant) otitis externa? Laryngoscope 2014;124:361–210.1002/lary.24093CrossRefGoogle ScholarPubMed
Matthews, PC, Conlon, CP, Berendt, AR, Kayley, J, Jefferies, L, Atkins, BL et al. Outpatient parenteral antimicrobial therapy (OUT-PATIENT PARENTERAL ANTIBIOTIC THERAPY): is it safe for selected patients to self-administer at home? A retrospective analysis of a large cohort over 13 years. J Antimicrob Chemother 2007;60:356–6210.1093/jac/dkm210CrossRefGoogle Scholar
van Kroonenburgh, AMJL, van der Meer, WL, Bothof, RJP, van Tilburg, M, van Tongeren, J, Postma, AA. Advanced imaging techniques in skull base osteomyelitis due to malignant otitis externa. Curr Radiol Rep 2018;6:3CrossRefGoogle ScholarPubMed
Rozenblum-Beddok, L, Verillaud, B, Paycha, F, Vironneau, P, Abulizi, M, Benada, A et al. 99mTc-HMPAO-leukocyte scintigraphy for diagnosis and therapy monitoring of skull base osteomyelitis. Laryngoscope Investig Otolaryngol 2018;14:218–2410.1002/lio2.159CrossRefGoogle Scholar
Vion, PA, Verillaud, B, Paycha, F, Benada, A, El-Deeb, G, Herman, P et al. 99m Tc-HMPAO-leucocyte scintigraphy and [18F]FDG-PET/CT for diagnosis and therapy monitoring in eleven patients with skull base osteomyelitis. Clin Otolaryngol 2020;45:591–410.1111/coa.13528CrossRefGoogle ScholarPubMed
Moss, WJ, Finegersh, A, Narayanan, A, Chan, JYK. Meta-analysis does not support routine traditional nuclear medicine studies for malignant otitis. Laryngoscope 2020;130:1812–16CrossRefGoogle Scholar
Kulkarni, SC, Padma, S, Shanmuga Sundaram, P. In the evaluation of patients with skull base osteomyelitis, does 18F-FDG PET CT have a role? Nucl Med Commun 2020;41:550–910.1097/MNM.0000000000001187CrossRefGoogle ScholarPubMed
Stern Shavit, S, Bernstine, H, Sopov, V, Nageris, B, Hilly, O. FDG-PET/CT for diagnosis and follow-up of necrotizing (malignant) external otitis. Laryngoscope 2019;129:961–6CrossRefGoogle ScholarPubMed
Rosenfeld, RM, Schwartz, SR, Ron Cannon, C, Roland, PS, Simon, GR, Kumar, KA et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg 2014;150:S124CrossRefGoogle ScholarPubMed