Necrotizing Otitis Externa: A 5 years perspective on Treatment Outcomes and Prognostic Factors

Purpose Necrotizing otitis externa is a life-threatening infection of the external ear and skull base, primarily affecting elderly, diabetic, and immunocompromised patients. This study reviews clinical presentations, microbiological profiles, treatment outcomes, and prognostic factors. Methods A retrospective analysis was conducted at the Otorhinolaryngology Department of Mohammed VI University Hospital, Marrakech, including 39 patients hospitalized with necrotizing otitis externa between January 2020 and December 2024. Data included clinical assessments, laboratory markers (erythrocyte sedimentation rate), microbiological cultures, and high-resolution computed tomography imaging. All patients received systemic antimicrobial therapy and were followed for at least 6 months. Results The cohort (mean age 61.1 years; male-to-female ratio 2.25:1) had diabetes mellitus in 63.3% of cases, with 55.6% showing poor glycemic control (hemoglobin A1c greater than 7%). Common symptoms were severe otalgia (89.7%) and otorrhea (30.7%). Facial nerve palsy occurred in 18%. Microbiological analysis revealed Pseudomonas aeruginosa in 30% of cases and fungal pathogens in 23%. Erythrocyte sedimentation rate was elevated in 92%, with significantly higher values in fungal infections. Computed tomography imaging showed temporal bone erosion in 56.4%. Treatment involved combined intravenous ceftazidime and ciprofloxacin for 6–8 weeks, with systemic antifungals added for fungal infections. Complete resolution was achieved in 69.2% of patients; 30.8% had persistent disease requiring prolonged therapy. Conclusion Necrotizing otitis externa management requires long-term, targeted antimicrobial treatment guided by culture results and inflammatory markers. The emerging prevalence of fungal pathogens and rising antibiotic resistance necessitate updated treatment protocols.