Department of Otolaryngology, University of Florida, Gainesville, FL, USA.
Otolaryngol Head Neck Surg. 2010 Oct;143(4):506-9. doi: 10.1016/j.otohns.2010.06.924.
Necrotizing otitis externa (NOE) is a life-threatening condition that may be difficult to distinguish from other clinical entities. The purpose of this study was to assess the pitfalls associated with contemporary diagnosis and management of NOE.
Case series with chart review.
Tertiary referral center.
Patients given the diagnosis of NOE or one of its typical presenting complaints over the past 14 years were identified by diagnostic and radiology codes. Charts were reviewed for history, findings, treatment, and outcomes.
Fifty-one patients with NOE were identified. The annual case numbers rose steadily. A risk factor was known in 46 patients. Gallium single-photon emission computed tomography was accurate for the presence (44 of 46 patients) and resolution of disease. Prolonged systemic antimicrobial therapy (mean 15 weeks, range 4-59 weeks) was required. Microbial cultures influenced therapy in only 50 percent. Two diabetic men died with disease. Of the cases seen at the request of otolaryngologists, 68 percent were for indications other than NOE (e.g., chronic otitis media). With a known risk such as diabetes, the mean time to diagnosis was 6.9 months. History of and clinical appearance overlapping with benign otitis were the primary reasons for diagnostic delay.
NOE remains a life-threatening condition that requires prolonged antimicrobial therapy. Its incidence may be on the rise. NOE may develop in patients with benign otitis media and externa, and must be considered in all patients with temporal bone inflammation, especially those with risk factors and those who fail to improve with more conservative measures.
坏死性外耳道炎（NOE）是一种危及生命的疾病，可能难以与其他临床实体区分。本研究旨在评估当代诊断和治疗 NOE 相关的陷阱。
病例系列和图表回顾。
三级转诊中心。
通过诊断和放射学代码，确定过去 14 年来被诊断为 NOE 或其典型表现之一的患者。回顾了病史、检查结果、治疗和结局。
确定了 51 例 NOE 患者。每年的病例数稳步上升。46 例患者有已知的危险因素。镓单光子发射计算机断层扫描（SPECT）对疾病的存在（46 例患者中的 44 例）和缓解均准确。需要长期全身抗菌治疗（平均 15 周，范围 4-59 周）。微生物培养仅在 50%的情况下影响治疗。两名糖尿病男性死于疾病。耳鼻喉科医生要求的病例中，68%的病例并非因 NOE 引起（例如慢性中耳炎）。有糖尿病等已知危险因素时，平均诊断时间为 6.9 个月。与良性中耳炎重叠的病史和临床表现是导致诊断延迟的主要原因。
NOE 仍然是一种危及生命的疾病，需要长期的抗菌治疗。其发病率可能呈上升趋势。良性中耳炎和外耳道炎患者可能会发生 NOE，因此必须考虑所有患有颞骨炎症的患者，尤其是有危险因素且对更保守治疗措施无改善的患者。
