Increasing Malignant Otitis Externa Admissions to U.S. Teaching Hospitals Over the Past 2 Decades

Objective: To examine national trends in the hospitalization of patients with malignant otitis externa (MOE), with a specific focus on the proportion of admissions to teaching versus nonteaching hospitals. Study design: Retrospective cohort study using a national database (National Inpatient Sample). Setting: United States inpatient hospitalizations from 1998 to 2021. Patients: Adult patients (18 y or older) admitted with a primary diagnosis of malignant otitis externa. Interventions: Not applicable. Main outcome measures: Admission to a teaching versus a nonteaching hospital. Multivariate logistic regression identified demographic and clinical factors associated with hospital-type admission. Temporal trends were analyzed over the 24-year period. Results: A total of 16,540 MOE admissions were identified. Admissions to teaching hospitals increased by 290.6% from 1998 to 2021, while nonteaching hospital admissions decreased by 55.8%. Teaching hospitals accounted for 57.7% of all MOE admissions and treated patients with higher comorbidity burdens. On multivariate analysis, factors independently associated with teaching hospital admission included Black race (OR: 2.56, P <0.001), Hispanic ethnicity (OR: 1.54, P =0.004), Medicaid insurance (OR: 1.60, P =0.001), diabetes with complications (OR: 1.86, P <0.001), HIV/AIDS (OR: 5.08, P =0.01), and metastatic cancer (OR: 8.66, P =0.02). Each successive year increased the odds of teaching hospital admission by 8% (OR: 1.08, P <0.001). Conclusions: MOE admissions in the U.S. have shifted significantly toward teaching hospitals over the past 2 decades, with these centers treating patients with greater medical complexity and immunocompromising conditions. These findings underscore the increasing centralization of MOE care at academic centers, raising important considerations about health care access, equity, and resource allocation. Level of Evidence: Level III.