185 Examining the Efficiency of Diagnosing and Managing Necrotising Otitis Externa (NOE) Using a Departmental Management Algorithm

Aim The audit aimed to evaluate a new NOE treatment algorithm's proficiency and the benefits of combining CT and Technetium Scan in comparison to CT alone for diagnosing and managing NOE. Method Patients admitted to Portsmouth Hospitals University NHS Trust between July 2021, and July 2023, with a possible or confirmed NOE diagnosis were examined. Among 37 identified patients, 33 were included, excluding those diagnosed with Squamous Cell Carcinoma. Patient records were analysed with the NOE algorithm to evaluate its effectiveness in diagnosing and managing NOE. Results Out of 33 patients (23 males, 10 females, mean age 77), 41% were diabetic. Ear swab results indicated 69.6% with pseudomonas, with 86.9% sensitive to Ceftazidime or Ciprofloxacin. NOE was confirmed in 60.6% (20/33) through CT. 7/13 patients with negative CT results underwent Technetium imaging, yielding a positive result in 4/7 of those cases. One patient was diagnosed with NOE via MRI. Technetium-negative patients received topical therapy and outpatient review. 25/33 radiologically diagnosed NOE patients and 3/33 with high clinical suspicion received 6 weeks of extended antibiotic therapy. 24/28 NOE-treated patients had an ENT follow-up in an average of 5.6 weeks. No recurrences or NOE-related mortalities were identified during follow-ups. Conclusions Technetium imaging influenced management in 30% of cases with a negative CT, making up 12% of the total study population. Without it, these patients might have overlooked extended antibiotic therapy, risking NOE complications. The algorithm was mostly adhered to, successfully identifying, and managing NOE patients with extended antibiotics, demonstrating no recurrence with no mortality since implementation.