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CC BY 4.0 · Int Arch Otorhinolaryngol 2025; 29(03): s00451809432
DOI: 10.1055/s-0045-1809432
Systematic Review

Advancements in the Treatment of Necrotizing Otitis Externa with Hyperbaric Oxygen: A Systematic Review

Autoren

  • Hassan Al Bazzal

    1   Department of Otolaryngology, Al Rayyan Hospital, Lebanon

  • Firas Hassan

    2   Department of Otolaryngology, Faculty of Medicine and Medical Sciences, University of Balamand, Lebanon

  • Mohamad Tlais

    2   Department of Otolaryngology, Faculty of Medicine and Medical Sciences, University of Balamand, Lebanon

  • Yehya Tlaiss 

    2   Department of Otolaryngology, Faculty of Medicine and Medical Sciences, University of Balamand, Lebanon

Funding The authors declare that they did not receive funding from agencies in the public, private, or non-profit sectors to conduct the present study.
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Abstract

Introduction

Necrotizing otitis externa (NOE), also known as malignant otitis externa (MOE), is a severe infection that begins in the external auditory canal and can extend to adjacent tissues and bone. It primarily affects elderly, diabetic, and immuno-compromised patients. Despite the advancements in antibiotics and surgical interventions, NOE remains a condition with significant morbidity and mortality.

Objective

To evaluate the efficacy of hyperbaric oxygen therapy (HBOT) as an adjunctive treatment for NOE, focusing on clinical outcomes and the potential benefits in refractory or advanced cases.

Methods

We conducted a comprehensive literature search on the PubMed/MEDLINE and Cochrane Library databases for articles published from January 1980 to December 2023. The search terms included hyperbaric oxygen therapy, necrotizing otitis externa, and refractory otitis. A total of 8 studies met the inclusion criteria, comprising case reports, observational studies, and case series. Study quality was assessed through the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale.

Results

The results indicate that HBOT shows promise in the treatment of NOE, with several studies reporting complete resolution of infection and prevention of recurrence, especially in refractory cases.

Conclusion

The current evidence is insufficient to establish HBOT as a standard treatment for NOE; however, its potential benefits in improving clinical outcomes and reducing morbidity are significant. High-quality research, including randomized controlled trials, is necessary to validate the role of HBOT in NOE treatment. Where hyperbaric facilities are accessible, HBOT should be considered for refractory NOE cases.

Keywords

hyperbaric oxygenation - otitis externa - necrotizing diabetes mellitus - adjuvant therapy


Publikationsverlauf

Eingereicht: 10. Oktober 2024

Angenommen: 31. Januar 2025

Artikel online veröffentlicht:
10. September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Hassan Al Bazzal, Firas Hassan, Mohamad Tlais, Yehya Tlaiss. Advancements in the Treatment of Necrotizing Otitis Externa with Hyperbaric Oxygen: A Systematic Review. Int Arch Otorhinolaryngol 2025; 29: s00451809432.
DOI: 10.1055/s-0045-1809432