943 An Audit of the Management of Necrotizing Otitis Externa Within Royal Devon and Exeter Hospital

Aim

To improve recognition and management of necrotizing otitis externa (NOE) early to prevent disease progression and reduce hospital admissions/length of stay.

Method

A retrospective audit of patients who were treated for NOE during an inpatient admission to the Royal Devon and Exeter Hospital between 1st December 2020 and 1st June 2022.

Results

A total of 15 cases were identified where symptoms were not attributable to an alternative diagnosis. Lab results, inpatient and clinic attendances were analysed to identify areas of improvement in terms of investigations and management.

The mean number of presentations before admission was 2.3. At admission 66% of patients had a swab taken and 7% of patients had imaging. Systemic antibiotics were prescribed in 20% of patients before admission.

IV antibiotics were started within 24 hours in all patients admitted. Microbiology consults were sent within 6 days in 93% of cases. The mean duration of IV antibiotics was 13 days, and the mean inpatient stay was 19 days.

Conclusions

The incidence of NOE is increasing in the UK, yet there is limited guidance and consensus on diagnosis and management. Some advice is provided by ENT UK, who suggest outpatient recognition might be improved by ensuring swabs and imaging are completed to reduce hospital admissions. In lower risk cases, starting oral ciprofloxacin may then aid with management. On admission investigations and management are being promptly started; however, an area for improvement could be the potential introduction of long lines for outpatient IV antibiotic therapy to reduce the length of hospital stays.