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Necrotizing External Otitis
Philip R. Chapman, MD; H. Ric Harnsberger, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Necrotizing external otitis (NEO)
            • Synonyms

              • Malignant external otitis, malignant otitis externa
              • Skull base osteomyelitis or typical skull base osteomyelitis
            • Definitions

              • NEO: Severe invasive infection of external auditory canal (EAC), adjacent soft tissues, and skull base

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Chapman PR et al: Skull base osteomyelitis: a comprehensive imaging review. AJNR Am J Neuroradiol. 42(3):404-13, 2021
                                          2. Morales RE et al: Imaging necrotizing otitis externa. Semin Roentgenol. 54(3):215-26, 2019
                                          3. Stern Shavit S et al: FDG-PET/CT for diagnosis and follow-up of necrotizing (malignant) external otitis. Laryngoscope. 129(4):961-6, 2019
                                          4. van der Meer WL et al: A persistent foramen of Huschke: a small road to misery in necrotizing external otitis. AJNR Am J Neuroradiol. 40(9):1552-6, 2019
                                          5. van Kroonenburgh AMJL et al: Advanced imaging techniques in skull base osteomyelitis due to malignant otitis externa. Curr Radiol Rep. 6(1):3, 2018
                                          6. Mingkwansook V et al: CT findings in the external auditory canal after transcanal surgery. AJNR Am J Neuroradiol. 36(5):982-6, 2015
                                          7. Le Clerc N et al: Skull base osteomyelitis: incidence of resistance, morbidity, and treatment strategy. Laryngoscope. 124(9):2013-6, 2014
                                          8. Nawas MT et al: Complicated necrotizing otitis externa. Am J Otolaryngol. 34(6):706-9, 2013
                                          9. Adams A et al: Central skull base osteomyelitis as a complication of necrotizing otitis externa: Imaging findings, complications, and challenges of diagnosis. Clin Radiol. 67(10):e7-e16, 2012
                                          10. Franco-Vidal V et al: Necrotizing external otitis: a report of 46 cases. Otol Neurotol. 28(6):771-3, 2007
                                          11. Mani N et al: Cranial nerve involvement in malignant external otitis: implications for clinical outcome. Laryngoscope. 117(5):907-10, 2007
                                          12. Kwon BJ et al: MRI findings and spreading patterns of necrotizing external otitis: is a poor outcome predictable? Clin Radiol. 61(6):495-504, 2006
                                          13. Rubin Grandis J et al: The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis. 4(1):34-9, 2004
                                          14. Grandis JR et al: Necrotizing (malignant) external otitis: prospective comparison of CT and MR imaging in diagnosis and follow-up. Radiology. 196(2):499-504, 1995
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Necrotizing external otitis (NEO)
                                                    • Synonyms

                                                      • Malignant external otitis, malignant otitis externa
                                                      • Skull base osteomyelitis or typical skull base osteomyelitis
                                                    • Definitions

                                                      • NEO: Severe invasive infection of external auditory canal (EAC), adjacent soft tissues, and skull base

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Nuclear Medicine Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Chapman PR et al: Skull base osteomyelitis: a comprehensive imaging review. AJNR Am J Neuroradiol. 42(3):404-13, 2021
                                                                                  2. Morales RE et al: Imaging necrotizing otitis externa. Semin Roentgenol. 54(3):215-26, 2019
                                                                                  3. Stern Shavit S et al: FDG-PET/CT for diagnosis and follow-up of necrotizing (malignant) external otitis. Laryngoscope. 129(4):961-6, 2019
                                                                                  4. van der Meer WL et al: A persistent foramen of Huschke: a small road to misery in necrotizing external otitis. AJNR Am J Neuroradiol. 40(9):1552-6, 2019
                                                                                  5. van Kroonenburgh AMJL et al: Advanced imaging techniques in skull base osteomyelitis due to malignant otitis externa. Curr Radiol Rep. 6(1):3, 2018
                                                                                  6. Mingkwansook V et al: CT findings in the external auditory canal after transcanal surgery. AJNR Am J Neuroradiol. 36(5):982-6, 2015
                                                                                  7. Le Clerc N et al: Skull base osteomyelitis: incidence of resistance, morbidity, and treatment strategy. Laryngoscope. 124(9):2013-6, 2014
                                                                                  8. Nawas MT et al: Complicated necrotizing otitis externa. Am J Otolaryngol. 34(6):706-9, 2013
                                                                                  9. Adams A et al: Central skull base osteomyelitis as a complication of necrotizing otitis externa: Imaging findings, complications, and challenges of diagnosis. Clin Radiol. 67(10):e7-e16, 2012
                                                                                  10. Franco-Vidal V et al: Necrotizing external otitis: a report of 46 cases. Otol Neurotol. 28(6):771-3, 2007
                                                                                  11. Mani N et al: Cranial nerve involvement in malignant external otitis: implications for clinical outcome. Laryngoscope. 117(5):907-10, 2007
                                                                                  12. Kwon BJ et al: MRI findings and spreading patterns of necrotizing external otitis: is a poor outcome predictable? Clin Radiol. 61(6):495-504, 2006
                                                                                  13. Rubin Grandis J et al: The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis. 4(1):34-9, 2004
                                                                                  14. Grandis JR et al: Necrotizing (malignant) external otitis: prospective comparison of CT and MR imaging in diagnosis and follow-up. Radiology. 196(2):499-504, 1995