European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 12, pp 2941–2945 | Cite as

The significance of tissue biopsy for fungi in necrotizing otitis externa

  • Rani Abu Eta
  • Haim GavrielEmail author
  • Kleid Stephen
  • Ephraim Eviatar
  • Eyal Yeheskeli



The conventional treatment for necrotizing otitis externa (NOE) is prolonged anti-pseudomonas therapy, with surgical treatment in non-responsive patients. The aim of the present study is to describe the course of management of patients with non-responsive NOE undergoing hyperbaric oxygen therapy (HBOT), and to investigate the importance of tissue biopsy for fungi in this group of patients.

Materials and methods

A retrospective study conducted between January 2010 and December 2013 at an Otolaryngology Head and Neck Surgery Department. Included were all 52 patients with NOE referred to our Medical Centre for further treatment including HBOT.


Fifty-two consecutive patients, 29 men and 23 women, with a mean age of 70.6 years, were included in our study. Twenty seven (51.9%) underwent surgical debridement. No significant difference was found between the group having surgical intervention, and those who did not, with regard to sex, age, comorbidities, cranial nerve involvement or laboratory results. However, those who had surgical intervention had a statistically significant higher rate of fungal infection (P = 0.049). After completing 7 weeks of HBOT, a significantly lower WBC count was observed in the fungus-infected group (7000 vs 7.800, P = 0.03), and a tendency towards lower CRP levels in the fungus-infected group (16 vs 58, P = 0.087).


Patients with NOE should have a comprehensive surgical intervention when delayed healing is observed, because proper fungal culturing might change the course of treatment and improve prognosis.

Level of evidence



Fungi Necrotizing external otitis Prognosis Hyperbaric oxygen therapy Treatment 



There is no direct or indirect commercial financial incentive associated with publishing the article; there is no extra-institutional funding.

Compliance with ethical standards

Conflict of interest

There are no possible conflicts of interest.

Ethical approval

There are no sources of financial support, corporate involvement, patent holdings, etc., for our research/study; and there is no ethical problem.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Departments of Otolaryngology Head and Neck SurgeryAssaf Harofeh Medical CenterZerifinIsrael
  2. 2.Sackler Faculty of MedicineTel Aviv UniversityRamat AvivIsrael
  3. 3.Department of Surgical OncologyPeter MacCallum Cancer InstituteMelbourneAustralia

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