Value of Hyperbaric oxygen as an adjuvant treatment for necrotizing otitis externa

Abstract

Background: Necrotizing otitis externa (NOE) is an acute infective process of the external auditory canal that could progress leading to skull base osteomyelitis. Hyperbaric oxygen therapy (HBOT) is considered an adjunctive therapy for NOE. HBOT is the administration of 100% oxygen at increased atmospheric pressure delivering increased oxygen partial pressure to the cells.Objective: The purpose is to evaluate the effectiveness of HBOT as an adjuvant for NOE management.Methods: twenty-two patients who had NOE were evaluated clinically and radiologically before treatment and the follow up duration was every three months. The antibiotic used was oral ciprofloxacin combined with ceftazidime. HBOT was administrated for period of 60 minutes once daily for 20 sessions and was repeated when needed. Factors as age, sex, otorrhea, complications, pain, laboratory changes, hospital stay and recurrence had been studied.Results: 22 patients were classified into two groups: group A was treated with antibiotic therapy and HBOT and group B only received the antibiotic therapy. The pain severity showed quite improvement as it decreased from score 6.82±1.17 to 1.09±1.22 after 1 month in group A, while in patients who were treated only with the antibiotics the pain severity score decreased from 6.36±1.12 to 2.82±1.60 which shows a significant difference between both study groups in favor of hyperbaric oxygen. After HBOT the mean ESR was 20.09±7.58 which is significantly lower than antimicrobial therapy alone group 34.46±12.88.Conclusions:Addition of HBOT to microbial therapy is effective with better results in NOE.