The association between radiological spreading pattern and clinical outcomes in necrotizing external otitis

W Leentje van der Meer, Ahmed B Bayoumy*, Josje J Otten, Jerome J Waterval, Henricus P M Kunst, Alida A Postma

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives: Necrotizing external otitis (NEO) is a rare infectious disease of the skull base. The purpose of this study was to determine whether clinical outcomes of NEO can be correlated to different infectious spread patterns.Methods: Retrospective chart review from 2010 to 2019 with NEO patients, who were divided into two cohorts: single spreading patterns (group A) or complex spreading patterns (group B) as diagnosed by CT. Clinical symptoms, diagnostic and treatment delay, course of disease, complications, and duration of antibiotic exposure were retrospectively collected from patient records.Results: 41 NEO patients were included, of which 27 patients belonged to group A (66%). The disease -related mortality rate was 12.2% among the entire cohort, no differences were found between group A and B. Higher rates of N.VII (42.9% vs 14.8% P = 0.047) and N. IX palsies were found in group B compared to group A (28.6% vs 3.7%, P = 0.039). The median duration of antibiotic use was significantly different for a complex spreading pattern, clinical recovery and hospitalizations. Complications were associated with higher diagnostic delay and with a complex spread pattern. The median duration of follow-up was 12.0 (IQR 6.0-19.5) months.Conclusion: NEO is a severe disease, with significant mortality and morbidity (cranial nerve palsies). The radiological spread pattern may assist in predicting clinical outcome. Furthermore, complex spread patterns are associated with higher rates of clinical nerve palsies (N. VII and N.IX), complications, surgery rates and longer duration of antibiotic use. Diagnostic delay was associated with mortality, complications and facial palsies.Level of evidence: Level IV.(c) 2022 PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (
Original languageEnglish
Pages (from-to)156-163
Number of pages8
JournalJournal of Otology
Issue number3
Publication statusPublished - Jul 2022


  • Necrotizing external otitis
  • Malignant external otitis
  • Skull base osteomyelitis
  • Clinical manifestation
  • Spreading routes
  • Antibiotic exposure
  • Facial nerve palsy

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