{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T02:01:27Z","timestamp":1785290487752,"version":"3.55.0"},"reference-count":56,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:p>\n                    <jats:bold>Introduction:<\/jats:bold>\n                    Malignant otitis externa (MOE) is an aggressive infection of the external auditory canal and the underlying bony structures of the skull base. Predominantly caused by Pseudomonas, the treatment has shifted from surgical to medical, with antimicrobial therapy being primary, although surgical intervention may still be required. This review aims to provide global prevalence and mortality data on MOE to help institutions establish treatment benchmarks.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    A systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Searches were completed in Scopus and PubMed Databases for articles on MOE mortality published between 1994 and 2022. Publications included data on MOE, mortality, and all genders.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    A total of 22 studies involving 9,633 patients diagnosed with MOE were analyzed. The gender distribution was nearly equal, with 4,819 (50.1%) males and 4,814 (49.9%) females. The patients\u2019 ages ranged from 18 to 90 years, with a mean age of 70.3 years. The pooled period prevalence of mortality due to MOE was estimated to be 18% (95% confidence interval: 6\u201330%), highlighting a significant mortality risk in patients with this condition. Heterogeneity across the studies was high (I2 = 99%,\n                    <jats:italic>p<\/jats:italic>\n                    &lt; 0.001). Additionally, the prevalence of comorbidities was significant: 57.1% of patients were diabetic, 51% had hypertension, and other notable comorbidities included chronic pulmonary diseases (12.2%), liver disease (7.2%), and malignancies (3.4%). The most common microbiological cause was Pseudomonas aeruginosa (30%), followed by Staphylococcus aureus (10%). Surgical interventions were performed in 3.7% of cases, and cranial nerve involvement was reported in 9% of patients, primarily affecting the facial nerve (91%). Morbidity related to MOE was found to be 15.2%, and sepsis was a complication in 0.5% of cases. The results underscore the importance of addressing both comorbidities and mortality risks in managing MOE patients.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    This review highlights a significant global mortality rate of 18% in patients with MOE, with comorbidities like diabetes and hypertension contributing to worse outcomes. Despite current treatment advancements, mortality and morbidity remain substantial, stressing the need for early diagnosis, targeted interventions, and improved management strategies to enhance patient survival and outcomes.\n                  <\/jats:p>","DOI":"10.5339\/qmj.2025.53","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T06:30:48Z","timestamp":1750141848000},"source":"Crossref","is-referenced-by-count":1,"title":["Mortality of malignant otitis externa: A prevalence meta-analysis"],"prefix":"10.5339","volume":"2025","author":[{"given":"Adham A.","family":"Aljariri","sequence":"first","affiliation":[{"name":"Otolaryngology Department, Ambulatory Care Center (ACC), Hamad Medical Corporation (HMC), Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad R.","family":"Al-Qudimat","sequence":"additional","affiliation":[{"name":"Department of Surgery, Surgical Research Section, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rani","family":"Hammoud","sequence":"additional","affiliation":[{"name":"Otolaryngology Department, Ambulatory Care Center (ACC), Hamad Medical Corporation (HMC), Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulqadir J.","family":"Nashwan","sequence":"additional","affiliation":[{"name":"Department of Quality and Patient Safety, Rehabilitation Institute, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisha Y.","family":"Larem","sequence":"additional","affiliation":[{"name":"Otolaryngology Department, Ambulatory Care Center (ACC), Hamad Medical Corporation (HMC), Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed B.","family":"Al Darwish","sequence":"additional","affiliation":[{"name":"Department of Surgery, Surgical Research Section, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassanin","family":"Abdulkarim","sequence":"additional","affiliation":[{"name":"Otolaryngology Department, Ambulatory Care Center (ACC), Hamad Medical Corporation (HMC), Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasser","family":"Hamad","sequence":"additional","affiliation":[{"name":"Department of Nursing, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar*Correspondence: Ahmad R. Al-Qudimat aalqudimat@hamad.qa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousra M.","family":"Khair","sequence":"additional","affiliation":[{"name":"Department of Surgery, Surgical Research Section, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amna S.","family":"Makawi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Surgical Research Section, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan H.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Otolaryngology Department, Ambulatory Care Center (ACC), Hamad Medical Corporation (HMC), Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Asaadi","sequence":"additional","affiliation":[{"name":"Otolaryngology Department, Ambulatory Care Center (ACC), Hamad Medical Corporation (HMC), Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulsalam","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"Otolaryngology Department, Ambulatory Care Center (ACC), Hamad Medical Corporation (HMC), Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad A.","family":"Abujaber","sequence":"additional","affiliation":[{"name":"Department of Quality and Patient Safety, Rehabilitation Institute, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3277","reference":[{"issue":"(9)","key":"CIT0001","series-title":"Ann Otol Rhinol Laryngol","first-page":"848\u201354","article-title":"Effective inexpensive management of necrotizing otitis externa is possible in resource-poor settings","volume":"128","author":"Honnurappa\n \nV","year":"2019;"},{"issue":"(5)","key":"CIT0002","series-title":"Eur Arch Otorhinolaryngol","first-page":"1327\u201334","article-title":"Surgery for necrotizing otitis externa-indications and surgical findings","volume":"277","author":"Peled\n \nC","year":"2020;"},{"issue":"(4)","key":"CIT0003","series-title":"Diabetes Ther","first-page":"629\u201338","article-title":"Malignant external otitis: what the diabetes specialist should know-a narrative review","volume":"14","author":"Tsilivigkos\n \nC","year":"2023;"},{"issue":"(5)","key":"CIT0004","series-title":"Int J Surg","first-page":"336\u201341","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"8","author":"Moher\n \nD","year":"2010;"},{"issue":"(9)","key":"CIT0005","series-title":"J Clin Epidemiol","first-page":"934\u20139","article-title":"Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement","volume":"65","author":"Hoy\n \nD","year":"2012;"},{"issue":"(2)","key":"CIT0006","series-title":"Infection","first-page":"193\u2013203","article-title":"Aspergillus flavus malignant external otitis in a diabetic patient: case report and literature review","volume":"48","author":"Pichon\n \nM","year":"2020;"},{"issue":"(8)","key":"CIT0007","series-title":"Ann Otol Rhinol Laryngol","first-page":"514\u201320","article-title":"Malignant otitis externa outcomes: a study of the university healthsystem consortium database","volume":"127","author":"Hatch\n \nJL","year":"2018;"},{"issue":"(10)","key":"CIT0008","series-title":"Laryngoscope","first-page":"2328\u201336","article-title":"Malignant otitis externa hospitalizations: analysis of patient characteristics","volume":"127","author":"Sylvester\n \nMJ","year":"2017;"},{"issue":"(5)","key":"CIT0009","series-title":"Am J Otolaryngol","first-page":"425\u201330","article-title":"Malignant external otitis: factors predicting patient outcomes","volume":"37","author":"Stern Shavit\n \nS","year":"2016;"},{"issue":"(2)","key":"CIT0010","series-title":"J Pak Med Assoc","first-page":"271\u20133","article-title":"A case of orbital apex syndrome in a patient with malignant otitis externa","volume":"63","author":"Baig\n \nR","year":"2013;"},{"issue":"(6)","key":"CIT0011","series-title":"Otolaryngol Head Neck Surg","first-page":"991\u20136","article-title":"Malignant otitis externa: an Asian perspective on treatment outcomes and prognostic factors","volume":"148","author":"Loh\n \nS","year":"2013;"},{"issue":"(5)","key":"CIT0012","series-title":"Otolaryngol Head Neck Surg","first-page":"758\u201362","article-title":"Malignant external otitis: analysis of severe cases","volume":"144","author":"Soudry\n \nE","year":"2011;"},{"issue":"(3)","key":"CIT0013","series-title":"Otol Neurotol","first-page":"339\u201343","article-title":"Predicting outcome of malignant external otitis","volume":"29","author":"Joshua\n \nBZ","year":"2008;"},{"issue":"(10)","key":"CIT0014","series-title":"Arch Otolaryngol Head Neck Surg","first-page":"1002\u20134","article-title":"Characteristics and prognosis of malignant external otitis with facial paralysis","volume":"133","author":"Soudry\n \nE","year":"2007;"},{"issue":"(5)","key":"CIT0015","series-title":"Laryngoscope","first-page":"907\u201310","article-title":"Cranial nerve involvement in malignant external otitis: implications for clinical outcome","volume":"117","author":"Mani\n \nN","year":"2007;"},{"issue":"(1)","key":"CIT0016","series-title":"Ear Nose Throat J","first-page":"60\u20132","article-title":"Atypical presentation of cutaneous tuberculosis and a retropharyngeal neck abscess","volume":"85","author":"Agada\n \nFO","year":"2006;"},{"issue":"(1)","key":"CIT0017","series-title":"Otolaryngol Head Neck Surg","first-page":"121\u20135","article-title":"Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical presentation","volume":"133","author":"Singh\n \nA","year":"2005;"},{"issue":"(5)","key":"CIT0018","series-title":"J Laryngol Otol","first-page":"366\u20139","article-title":"Non-pseudomonal malignant otitis externa and jugular foramen syndrome secondary to cyclosporin-induced hypertrichosis in a diabetic renal transplant patient","volume":"114","author":"Lancaster\n \nJ","year":"2000;"},{"issue":"(4)","key":"CIT0019","series-title":"Clin Infect Dis","first-page":"1052\u20134","article-title":"Malignant external otitis due to Aspergillus flavus with fulminant dissemination to the lungs","volume":"20","author":"Harley\n \nWB","year":"1995;"},{"issue":"(2)","key":"CIT0020","series-title":"Acta Medica (Hradec Kralove)","first-page":"82\u20135","article-title":"Candida skull base osteomyelitis: a case report and literature review","volume":"63","author":"Krishnamoorthy\n \nM","year":"2020;"},{"issue":"(2)","key":"CIT0021","series-title":"Ear Nose Throat. J","first-page":"E1\u2013E5","article-title":"Is malignant otitis externa on the increase? A retrospective review of cases","volume":"96","author":"Bhasker\n \nD","year":"2017;"},{"issue":"(12)","key":"CIT0022","series-title":"Eur Arch Otorhinolaryngol","first-page":"4681\u20138","article-title":"The challenging diagnosis and follow-up of skull base osteomyelitis in clinical practice","volume":"278","author":"Auinger\n \nAB","year":"2021;"},{"issue":"(1)","key":"CIT0023","series-title":"Acta Otolaryngol","first-page":"89\u201394","article-title":"Outcomes of malignant external otitis: survival vs mortality","volume":"130","author":"Chen\n \nCN","year":"2010;"},{"issue":"(1)","key":"CIT0024","series-title":"Diagn Microbiol Infect Dis","first-page":"74\u20138","article-title":"Necrotizing otitis externa: diagnosis, treatment, and outcome in a case series","volume":"87","author":"Glikson\n \nE","year":"2017;"},{"issue":"(5)","key":"CIT0025","series-title":"Eur Arch Otorhinolaryngol","first-page":"1269\u201376","article-title":"Central skull base osteomyelitis: new insights and implications for diagnosis and treatment","volume":"272","author":"Ridder\n \nGJ","year":"2015;"},{"issue":"(Suppl 3)","key":"CIT0026","series-title":"Indian J Otolaryngol Head Neck Surg","first-page":"4422\u20137","article-title":"Clinical and current microbiological profile with changing antibiotic sensitivity in malignant otitis externa","volume":"74","author":"Sekar\n \nR","year":"2022;"},{"key":"CIT0027","series-title":"Am J Otolaryngol\u2013Head Neck Med Surg","first-page":"102894","article-title":"Malignant otitis externa: an updated review","volume":"42","author":"Gonzalez\n \nJ","year":"2021;"},{"issue":"(2)","key":"CIT0028","series-title":"Am J Otolaryngol","first-page":"102894","article-title":"Malignant otitis externa: an updated review","volume":"42","author":"Trevi\u00f1o Gonz\u00e1lez\n \nJL","year":"2021;"},{"issue":"(9)","key":"CIT0001","series-title":"Ann Otol Rhinol Laryngol","first-page":"848\u201354","article-title":"Effective inexpensive management of necrotizing 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prevalence studies: modification of an existing tool and evidence of interrater agreement","volume":"65","author":"Hoy\n \nD","year":"2012;"},{"issue":"(2)","key":"CIT0006","series-title":"Infection","first-page":"193\u2013203","article-title":"Aspergillus flavus malignant external otitis in a diabetic patient: case report and literature review","volume":"48","author":"Pichon\n \nM","year":"2020;"},{"issue":"(8)","key":"CIT0007","series-title":"Ann Otol Rhinol Laryngol","first-page":"514\u201320","article-title":"Malignant otitis externa outcomes: a study of the university healthsystem consortium database","volume":"127","author":"Hatch\n \nJL","year":"2018;"},{"issue":"(10)","key":"CIT0008","series-title":"Laryngoscope","first-page":"2328\u201336","article-title":"Malignant otitis externa hospitalizations: analysis of patient characteristics","volume":"127","author":"Sylvester\n \nMJ","year":"2017;"},{"issue":"(5)","key":"CIT0009","series-title":"Am J Otolaryngol","first-page":"425\u201330","article-title":"Malignant external otitis: factors predicting patient outcomes","volume":"37","author":"Stern Shavit\n \nS","year":"2016;"},{"issue":"(2)","key":"CIT0010","series-title":"J Pak Med Assoc","first-page":"271\u20133","article-title":"A case of orbital apex syndrome in a patient with malignant otitis externa","volume":"63","author":"Baig\n \nR","year":"2013;"},{"issue":"(6)","key":"CIT0011","series-title":"Otolaryngol Head Neck Surg","first-page":"991\u20136","article-title":"Malignant otitis externa: an Asian perspective on treatment outcomes and prognostic factors","volume":"148","author":"Loh\n \nS","year":"2013;"},{"issue":"(5)","key":"CIT0012","series-title":"Otolaryngol Head Neck Surg","first-page":"758\u201362","article-title":"Malignant external otitis: analysis of severe cases","volume":"144","author":"Soudry\n \nE","year":"2011;"},{"issue":"(3)","key":"CIT0013","series-title":"Otol Neurotol","first-page":"339\u201343","article-title":"Predicting outcome of malignant external otitis","volume":"29","author":"Joshua\n \nBZ","year":"2008;"},{"issue":"(10)","key":"CIT0014","series-title":"Arch Otolaryngol Head Neck Surg","first-page":"1002\u20134","article-title":"Characteristics and prognosis of malignant external otitis with facial paralysis","volume":"133","author":"Soudry\n \nE","year":"2007;"},{"issue":"(5)","key":"CIT0015","series-title":"Laryngoscope","first-page":"907\u201310","article-title":"Cranial nerve involvement in malignant external otitis: implications for clinical outcome","volume":"117","author":"Mani\n \nN","year":"2007;"},{"issue":"(1)","key":"CIT0016","series-title":"Ear Nose Throat J","first-page":"60\u20132","article-title":"Atypical presentation of cutaneous tuberculosis and a retropharyngeal neck abscess","volume":"85","author":"Agada\n \nFO","year":"2006;"},{"issue":"(1)","key":"CIT0017","series-title":"Otolaryngol Head Neck Surg","first-page":"121\u20135","article-title":"Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical presentation","volume":"133","author":"Singh\n \nA","year":"2005;"},{"issue":"(5)","key":"CIT0018","series-title":"J Laryngol Otol","first-page":"366\u20139","article-title":"Non-pseudomonal malignant otitis externa and jugular foramen syndrome secondary to cyclosporin-induced hypertrichosis in a diabetic renal transplant patient","volume":"114","author":"Lancaster\n \nJ","year":"2000;"},{"issue":"(4)","key":"CIT0019","series-title":"Clin Infect Dis","first-page":"1052\u20134","article-title":"Malignant external otitis due to Aspergillus flavus with fulminant dissemination to the lungs","volume":"20","author":"Harley\n \nWB","year":"1995;"},{"issue":"(2)","key":"CIT0020","series-title":"Acta Medica (Hradec Kralove)","first-page":"82\u20135","article-title":"Candida skull base osteomyelitis: a case report and literature review","volume":"63","author":"Krishnamoorthy\n \nM","year":"2020;"},{"issue":"(2)","key":"CIT0021","series-title":"Ear Nose Throat. J","first-page":"E1\u2013E5","article-title":"Is malignant otitis externa on the increase? A retrospective review of cases","volume":"96","author":"Bhasker\n \nD","year":"2017;"},{"issue":"(12)","key":"CIT0022","series-title":"Eur Arch Otorhinolaryngol","first-page":"4681\u20138","article-title":"The challenging diagnosis and follow-up of skull base osteomyelitis in clinical practice","volume":"278","author":"Auinger\n \nAB","year":"2021;"},{"issue":"(1)","key":"CIT0023","series-title":"Acta Otolaryngol","first-page":"89\u201394","article-title":"Outcomes of malignant external otitis: survival vs mortality","volume":"130","author":"Chen\n \nCN","year":"2010;"},{"issue":"(1)","key":"CIT0024","series-title":"Diagn Microbiol Infect Dis","first-page":"74\u20138","article-title":"Necrotizing otitis externa: diagnosis, treatment, and outcome in a case series","volume":"87","author":"Glikson\n \nE","year":"2017;"},{"issue":"(5)","key":"CIT0025","series-title":"Eur Arch Otorhinolaryngol","first-page":"1269\u201376","article-title":"Central skull base osteomyelitis: new insights and implications for diagnosis and treatment","volume":"272","author":"Ridder\n \nGJ","year":"2015;"},{"issue":"(Suppl 3)","key":"CIT0026","series-title":"Indian J Otolaryngol Head Neck Surg","first-page":"4422\u20137","article-title":"Clinical and current microbiological profile with changing antibiotic sensitivity in malignant otitis externa","volume":"74","author":"Sekar\n \nR","year":"2022;"},{"key":"CIT0027","series-title":"Am J Otolaryngol\u2013Head Neck Med Surg","first-page":"102894","article-title":"Malignant otitis externa: an updated review","volume":"42","author":"Gonzalez\n \nJ","year":"2021;"},{"issue":"(2)","key":"CIT0028","series-title":"Am J Otolaryngol","first-page":"102894","article-title":"Malignant otitis externa: an updated review","volume":"42","author":"Trevi\u00f1o Gonz\u00e1lez\n \nJL","year":"2021;"}],"container-title":["Qatar Medical Journal"],"original-title":[],"link":[{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2025\/2\/article-53.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2025\/2\/article-53.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2025\/2\/article-53.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:17:29Z","timestamp":1777310249000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2025\/2\/article-53.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":56,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.5339\/qmj.2025.53","relation":{},"ISSN":["2227-0426"],"issn-type":[{"value":"2227-0426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025]]}}}