{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:07:27Z","timestamp":1792624047302,"version":"4.5.0"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T00:00:00Z","timestamp":1695686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int Arch Otorhinolaryngol"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Introduction\u2003Necrotizing otitis externa has a high impact on the quality of life of patients and has shown a significant increase in its incidence in recent years. There has been a change in the profile of affected patients and a lack of consensus on the management of these patients.<\/jats:p><jats:p>\n          Objective\u2003To develop a practical and effective care protocol to standardize the diagnostic and therapeutic management of necrotizing otitis externa.<\/jats:p><jats:p>\n          Methods\u2003A retrospective cohort study of necrotizing otitis externa patients between January 2015 and December 2020.<\/jats:p><jats:p>\n          Results\u2003There were 34 patients with two bilateral cases, totaling 36 ears. The mean age was 68.5, with a higher prevalence of males (76%). Diabetes was present in 97% of the samples. The involvement of cranial pairs was identified in 35% of the sample. Pseudomonas aeruginosa was the most frequent pathogen isolated, found in 50% of the cases. Among the cultures with bacterial agents isolated, 35% showed resistance to ciprofloxacin. The most frequent exam was computed tomography (94%). Hospital admission was indicated for 31 patients (91%), and ceftazidime was the most prescribed drug (35.5%). There were 11 recurrences (32%), and 12 patients (35%) had complications during treatment. Among the unfavorable outcomes, 12% persisted with some degree of peripheral facial paralysis, 6% maintained dysphagia, and 9% died of the disease.<\/jats:p><jats:p>\n          Conclusions\u2003The present study developed a diagnostic and therapeutic protocol for the effective management of necrotizing otitis externa. This protocol is a dynamic tool and should be revised and updated as new demands emerge during its implementation.<\/jats:p>","DOI":"10.1055\/s-0042-1758719","type":"journal-article","created":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T22:58:43Z","timestamp":1695769123000},"page":"e706-e712","source":"Crossref","is-referenced-by-count":5,"title":["Necrotizing Otitis Externa: A Proposal for Diagnostic and Therapeutic Approach"],"prefix":"10.1055","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0788-7647","authenticated-orcid":false,"given":"Mar\u00edlia Batista","family":"Costa","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology - Head and Neck Surgery, Universidade Federal de S\u00e3o Paulo, Escola Paulista de Medicina, Sao Paulo, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1501-8409","authenticated-orcid":false,"given":"Ektor Tsuneo","family":"Onishi","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology - Head and Neck Surgery, Universidade Federal de S\u00e3o Paulo, Escola Paulista de Medicina, Sao Paulo, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,9,26]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1097\/SCS.0b013e31825e4d9a","article-title":"Malignant otitis externa","volume":"23","author":"E Karaman","year":"2012","journal-title":"J Craniofac Surg"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1017\/S0022215119000604","article-title":"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","volume":"133","author":"K H Hutson","year":"2019","journal-title":"J Laryngol Otol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/S0022215121003029","article-title":"Necrotising otitis externa: a serious condition becoming more frequently encountered","volume":"25","author":"A Z Eweiss","year":"2021","journal-title":"J Laryngol Otol"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"394","DOI":"10.5152\/iao.2017.4399","article-title":"Management of Necrotizing Otitis Externa: Our Experience with Forty-Three Patients","volume":"13","author":"S Sharma","year":"2017","journal-title":"J Int Adv Otol"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1111\/coa.13921","article-title":"Necrotising otitis externa antibiotic therapy complications: A retrospective cohort analysis","volume":"47","author":"A Ijaz","year":"2022","journal-title":"Clin Otolaryngol"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1097\/MAO.0000000000001986","article-title":"Necrotizing Otitis Externa-Analysis of 83 Cases: Clinical Findings and Course of Disease","volume":"40","author":"C Peled","year":"2019","journal-title":"Otol Neurotol"},{"issue":"06","key":"ref7","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.crad.2006.01.010","article-title":"MRI findings and spreading patterns of necrotizing external otitis: is a poor outcome predictable?","volume":"61","author":"B J Kwon","year":"2006","journal-title":"Clin Radiol"},{"issue":"09","key":"ref8","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1097\/00005537-200209000-00017","article-title":"Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa","volume":"112","author":"L Berenholz","year":"2002","journal-title":"Laryngoscope"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"72","DOI":"10.5152\/iao.2015.430","article-title":"Malignant Otitis Externa - A Retrospective Study of 15 Patients Treated in a Tertiary Healthcare Center","volume":"11","author":"V Bhat","year":"2015","journal-title":"J Int Adv Otol"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1097\/MAO.0000000000001812","article-title":"Imaging in the Diagnosis and Management of Necrotizing Otitis Externa: A Survey of Practice Patterns","volume":"39","author":"T Cooper","year":"2018","journal-title":"Otol Neurotol"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.anorl.2012.04.011","article-title":"Initial management of necrotizing external otitis: errors to avoid","volume":"130","author":"N Guevara","year":"2013","journal-title":"Eur Ann Otorhinolaryngol Head Neck Dis"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1080\/00016489.2022.2057586","article-title":"Diagnostic approach to patients at risk of otogenic skull base osteomyelitis","volume":"142","author":"J WJ Lim","year":"2022","journal-title":"Acta Otolaryngol"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"315","DOI":"10.2298\/SARH1606315D","article-title":"Recurrent malignant otitis externa with multiple cranial nerve involvement: A case report","volume":"144","author":"D Djeri\u0107","year":"2016","journal-title":"Srp Arh Celok Lek"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.amjoto.2016.04.005","article-title":"Malignant external otitis: Factors predicting patient outcomes","volume":"37","author":"S Stern Shavit","year":"2016","journal-title":"Am J Otolaryngol"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1053\/j.ro.2019.04.002","article-title":"Imaging Necrotizing Otitis Externa","volume":"54","author":"R E Morales","year":"2019","journal-title":"Semin Roentgenol"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1017\/S0022215117002237","article-title":"Necrotising otitis externa in the immunocompetent patient: case series","volume":"132","author":"S Unadkat","year":"2018","journal-title":"J Laryngol Otol"},{"issue":"06","key":"ref17","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1017\/S0022215120001061","article-title":"A retrospective review and multi-specialty, evidence-based guideline for the management of necrotising otitis externa","volume":"134","author":"M E Hopkins","year":"2020","journal-title":"J Laryngol Otol"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s40134-018-0263-y","article-title":"Advanced Imaging Techniques in Skull Base Osteomyelitis Due to Malignant Otitis Externa","volume":"6","author":"A MJL van Kroonenburgh","year":"2018","journal-title":"Curr Radiol Rep"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"98","DOI":"10.5152\/iao.2020.7709","article-title":"Malignant Otitis Externa: Causes for Various Treatment Responses","volume":"16","author":"N Arsovic","year":"2020","journal-title":"J Int Adv Otol"},{"issue":"05","key":"ref20","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1017\/S0022215116000323","article-title":"Temporomandibular joint involvement as a positive clinical prognostic factor in necrotising external otitis","volume":"130","author":"E Yeheskeli","year":"2016","journal-title":"J Laryngol Otol"},{"issue":"03","key":"ref21","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1111\/coa.13507","article-title":"A review of thirty-nine patients diagnosed with necrotising otitis externa over three years: Is CT imaging for diagnosis sufficient?","volume":"45","author":"K Lau","year":"2020","journal-title":"Clin Otolaryngol"},{"issue":"10","key":"ref22","doi-asserted-by":"crossref","first-page":"2328","DOI":"10.1002\/lary.26401","article-title":"Malignant otitis externa hospitalizations: Analysis of patient characteristics","volume":"127","author":"M J Sylvester","year":"2017","journal-title":"Laryngoscope"},{"issue":"01","key":"ref23","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.diagmicrobio.2016.10.017","article-title":"Necrotizing otitis externa: diagnosis, treatment, and outcome in a case series","volume":"87","author":"E Glikson","year":"2017","journal-title":"Diagn Microbiol Infect Dis"},{"issue":"09","key":"ref24","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1177\/0003489419846143","article-title":"Effective Inexpensive Management of Necrotizing Otitis Externa Is Possible in Resource-Poor Settings","volume":"128","author":"V Honnurappa","year":"2019","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"02","key":"ref25","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.joto.2019.01.003","article-title":"A retrospective review of 14 cases of malignant otitis externa","volume":"14","author":"S Marina","year":"2019","journal-title":"J Otol"},{"issue":"12","key":"ref27","doi-asserted-by":"crossref","first-page":"2941","DOI":"10.1007\/s00405-018-5151-9","article-title":"The significance of tissue biopsy for fungi in necrotizing otitis externa","volume":"275","author":"R Abu Eta","year":"2018","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"05","key":"ref28","first-page":"CD004617","article-title":"Hyperbaric oxygen as an adjuvant treatment for malignant otitis externa","author":"J S Phillips","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"issue":"03","key":"ref29","first-page":"239","article-title":"Necrotizing Otitis Externa: A Disease Barely Known to Neurosurgeons","volume":"38","author":"S AV Can\u00e7ado","year":"2019","journal-title":"Braz Neurosurg"},{"issue":"08","key":"ref30","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1177\/0003489418778056","article-title":"Malignant Otitis Externa Outcomes: A Study of the University HealthSystem Consortium Database","volume":"127","author":"J L Hatch","year":"2018","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"07","key":"ref31","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1007\/s00405-019-05396-7","article-title":"Malignant (necrotizing) externa otitis: the experience of a single hyperbaric centre","volume":"276","author":"C E Amaro","year":"2019","journal-title":"Eur Arch Otorhinolaryngol"}],"container-title":["International Archives of Otorhinolaryngology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0042-1758719.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T11:56:46Z","timestamp":1730807806000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0042-1758719"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,26]]},"references-count":30,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2023,10,23]]},"published-print":{"date-parts":[[2023,10]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0042-1758719","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1809-9777","1809-4864"],"issn-type":[{"value":"1809-9777","type":"print"},{"value":"1809-4864","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,26]]}}}