INTRODUCTION
Necrotising otitis externa (NOE) is a severe infection of the external auditory canal which can progress to skull base osteomyelitis, cranial nerve palsies, meningitis, and is frequently fatal (1). The incidence of NOE in the UK has risen almost 600% between 2002-2017 - which may be due to a concomitant rise in relevant risk factors such as advancing age and diabetes mellitus (2)(3). Treatment frequently involves prolonged treatment with parenteral antimicrobial therapy, which often necessitates an extended hospital admission and its associated risks, including nosocomial infection.
The extent of disease in NOE is variable and management remains contentious. Promise has been shown in other forms of osteomyelitis for early debridement and short course antimicrobial therapy (4). Although the application of this paradigm to NOE offers several advantages for patient care, the potential of de-escalation of treatment in selected cases of NOE remains to be demonstrated.