Necrotising Otitis Externa (NOE for short) is a severe ear infection that causes bad ear pain and hearing loss. Older people are particularly likely to get NOE, but it can also affect those with diabetes or a poor immune system.

In the worst cases, NOE leads to permanent paralysis of part of the face or long-term problems swallowing. The standard treatment offered is antibiotics, but this treatment itself can cause problems: older people might have to stay in a hospital to have the antibiotics delivered through a tube into their veins, and they are also at greater risk of antibiotic side-effects, especially if they have to take them for a long time (as is often the case with NOE). All of this means that, about 14% of people affected do not respond well to the treatment and die.

Despite this, and despite the recent increase in the number of people with NOE, there are no national or international guidelines for how to diagnose or treat NOE. As our population ages, more people are likely to get NOE, and so we have set up a network of more than 80 doctors to help us study NOE. This is the first group of specialists to work on NOE together internationally.

In this study, specialists working at a number of hospitals in the UK will keep detailed records of how they diagnose and treat NOE, and whether the treatment works. We will analyse this information to find out the risk factors for NOE, which scans and surgical samples are the best way to diagnose this disease, and which type and dose of antibiotics work best. Doctors currently do not know what is the best way to manage NOE, with different people trying different things – we hope that our analysis will formulate the optimal strategy for managing NOE and improve outcomes.

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