Evidence map›Paper›PMID 41044377›Full record

ArticleEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026

Fungal necrotizing otitis externa; challenges in diagnosis and therapy.

Gaelle Vofo, Ofir Zavdy, Rona Bourla, Hila Elinav, Maya Korem, Sarah Israel, Reut Book, Fatima Azhraa Haddad, Dvir Bar-On, Tomer Menzely and 2 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
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0citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Gaelle VofoDepartment of Otolaryngology- Head and Neck Surgery, Hadassah Medical Center, Jerusalem, 91120, Israel.
Ofir ZavdyDepartment of Otolaryngology, Head & Neck Surgery, Rabin Medical Centers, Petah Tikva, Israel.
Rona BourlaDepartment of Otolaryngology, Head & Neck Surgery, Rabin Medical Centers, Petah Tikva, Israel.
Hila ElinavDepartment of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem, Israel.
Maya KoremDepartment of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem, Israel.
Sarah IsraelDepartment of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem, Israel.
Reut BookDepartment of Otolaryngology- Head and Neck Surgery, Hadassah Medical Center, Jerusalem, 91120, Israel.
Fatima Azhraa HaddadDepartment of Otolaryngology- Head and Neck Surgery, Hadassah Medical Center, Jerusalem, 91120, Israel.
Dvir Bar-OnDepartment of Otolaryngology, Head & Neck Surgery, Rabin Medical Centers, Petah Tikva, Israel.
Tomer MenzelyDepartment of Otolaryngology, Head & Neck Surgery, Rabin Medical Centers, Petah Tikva, Israel.
Ohad HillyDepartment of Otolaryngology, Head & Neck Surgery, Rabin Medical Centers, Petah Tikva, Israel.
Sagit Stern ShavitDepartment of Otolaryngology- Head and Neck Surgery, Hadassah Medical Center, Jerusalem, 91120, Israel. sagitsternshavit@gmail.com.ORCID http://orcid.org/0000-0003-1675-8644

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeNecrotizing otitis externa (NOE) is a severe infection with potential skull base involvement. The role of fungal pathogens and the need for antifungal treatment remain controversial. We aimed to evaluate clinical characteristics, diagnostic challenges, and microbiology results in fungal NOE and assess considerations for antifungal therapy.

methodsThis retrospective cohort study was conducted at two tertiary centers. NOE patients, based on clinical and radiological findings, were retrospectively reviewed. Clinical characteristics, microbiological findings, and disease persistence were compared between patients categorized by antifungal treatment status: Combined antifungal-antibiotic therapy versus antibiotic therapy alone.

resultsOf 125 patients, 25 received combined treatment (13 as initial treatment and 12 after persistent disease) and 100 received antibiotics alone. Combined treatment patients were younger, had prolonged symptoms, and more cranial nerve palsy, requiring longer treatment for persistent and aggressive disease. Fungi were found in 72% of combined-treatment cultures, but most were deemed unreliable by infectious diseases specialists, inconsistently leading to antifungal therapy.

conclusionAntifungal therapy decisions in NOE lack standardization. We propose a protocol incorporating clinical and microbiological data to guide antifungal therapy. Prospective studies are needed to validate this protocol and establish standardized guidelines for fungal NOE treatment.

Indexed as

Anti-Bacterial AgentsAntifungal AgentsMycosesOtitis ExternaAdultAgedDrug Therapy, CombinationFemaleHumansMaleMiddle AgedNecrosisRetrospective StudiesAnti-Bacterial AgentsAntifungal AgentsFungal cultureFungal necrotizing otitis externaNecrotizing otitis externaPatient factorsPersistence/RecurrenceSystemic antifungal medication

Identifiers

PMID41044377
PMCPMC12904872

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.