Evaluation of Hyperbaric Oxygen Therapy as an Adjuvant Treatment for
Necrotising Otitis Externa: Retrospective, observational, case-control
study.
Abstract
Objectives Admission of patients with necrotising otitis externa (NOE)
has been rising steadily over the last five years and mortality and
morbidity associated with the disease is high. Our objective is to
assess the value of adjuvant hyperbaric oxygen therapy in patients with
necrotising otitis externa. Design and setting A retrospective,
observational, case-control study was conducted by examining patients’
records over a four-and-a-half-year period at two secondary care sites
in the UK. The (Non-HBO) control group treated conventionally and the
(HBO) group treated with additional adjuvant HBO in a multiple occupancy
therapy chamber at the James Paget University Hospital. The primary
outcome measure was death. Secondary outcomes measures were resolution
of pain and recovery from otalgia, facial nerve palsy and other cranial
nerve palsies. Results There were 10 patients in the HBO group and 20 in
the non-HBO group; mean age was 82.3 years and 88.3 years respectively.
The mortality rate was 30% in the HBO group compared to 55% in the
non-HBO group. Patients tolerated HBO well, had greater resolution of
pain (90% vs 64%) and resolution of facial nerve palsy (67% vs 31%)
than the non-HBO group. Resolution of other cranial neuropathies was
similar. Conclusion Our case series suggests that HBO is potentially a
life-saving intervention. It also suggests that patients treated with
HBO therapy for NOE appear to improve both in terms of pain and facial
nerve palsies compared with conventional treatment and sets the
precedent for a trial to formally compare the adjunctive intervention of
HBO.