{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T13:29:03Z","timestamp":1762867743509,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,2,9]]},"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:p>Necrotising otitis externa (NOE) is an infection originating in the soft tissues of the external auditory canal (EAC) spreading to the surrounding bone and rarely causing intracranial complications. It is usually caused by <jats:italic>Pseudomonas aeruginosa<\/jats:italic> and has historically occurred in elderly patients with diabetes or immunodeficiency. EAC foreign body is a risk factor for otitis externa but has not been described in NOE. A healthy 31-year-old man presented with new-onset seizures and worsening left-sided otalgia and otorrhoea. Brain imaging revealed left temporal subdural abscesses superior to the petrous bone. A retained cotton bud was identified in the left EAC, along with osseocartilaginous junction and mastoid granulation tissue. The foreign body was removed; a cortical mastoidectomy performed and intravenous antibiotic administered. At 10 weeks, the patient remained well, with no neurological deficit and no residual ear symptoms, and CT demonstrated complete resolution of the intracranial abscesses.<\/jats:p>","DOI":"10.1136\/bcr-2018-227971","type":"journal-article","created":{"date-parts":[[2019,3,7]],"date-time":"2019-03-07T04:45:34Z","timestamp":1551933934000},"page":"e227971","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Cotton bud in external ear canal causing necrotising otitis externa and subdural abscess"],"prefix":"10.1136","volume":"12","author":[{"given":"Alexander","family":"Charlton","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noor","family":"Janjua","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darius","family":"Rejali","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,3,6]]},"reference":[{"key":"2025082701224358000_12.3.e227971.1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00134-015-4124-3","article-title":"The reliability of the Glasgow coma scale: a systematic review","volume":"42","author":"Reith","year":"2016","journal-title":"Intensive Care Med"},{"key":"2025082701224358000_12.3.e227971.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2008.01.004"},{"key":"2025082701224358000_12.3.e227971.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2005.03.024"},{"key":"2025082701224358000_12.3.e227971.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(03)00858-2"},{"key":"2025082701224358000_12.3.e227971.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0709(80)80016-0"},{"key":"2025082701224358000_12.3.e227971.6","first-page":"40","article-title":"Our experience over the last four decades","volume":"13","author":"Laulajainen-Hongisto","year":"2017","journal-title":"The journal of international advanced otology"},{"key":"2025082701224358000_12.3.e227971.7","first-page":"104","article-title":"Intracranial complications of suppurative otitis media: 13 years' experience","volume":"16","author":"Kangsanarak","year":"1995","journal-title":"Am J Otol"},{"key":"2025082701224358000_12.3.e227971.8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/MAO.0000000000001842","article-title":"Giant Temporal Lobe Abscess in a Patient With Ectodermal Dysplasia","volume":"39","author":"Lapenna","year":"2018","journal-title":"Otol Neurotol"},{"key":"2025082701224358000_12.3.e227971.9","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215109005313"},{"key":"2025082701224358000_12.3.e227971.10","doi-asserted-by":"crossref","first-page":"2261","DOI":"10.1007\/s00405-015-3738-y","article-title":"Malignant otitis externa in a healthy non-diabetic patient","volume":"273","author":"Liu","year":"2016","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"2025082701224358000_12.3.e227971.11","first-page":"1317","article-title":"A case series from an italian tertiary-care hospital","volume":"30","author":"Galletti","year":"2014","journal-title":"Acta Medica Mediterranea"},{"key":"2025082701224358000_12.3.e227971.12","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1007\/s00405-014-2938-1","article-title":"Technetium-99m (99mTc)-labelled sulesomab in the management of malignant external otitis: is there any role?","volume":"272","author":"Galletti","year":"2015","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"2025082701224358000_12.3.e227971.13","first-page":"14","article-title":"Malignant otitis externa--a high index of suspicion is still needed for diagnosis","volume":"95","author":"Walshe","year":"2002","journal-title":"Ir Med J"},{"key":"2025082701224358000_12.3.e227971.14","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":"Sylvester","year":"2017","journal-title":"Laryngoscope"},{"key":"2025082701224358000_12.3.e227971.15","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1017\/S002221511500105X","article-title":"Necrotising (malignant) otitis externa in the UK: a growing problem. 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