Cotton bud foreign body associated necrotising otitis externa – a case series and literature review

Introduction: Necrotising otitis externa (NOE) requires a high index of clinical suspicion in patients who use off-label cotton buds or Q-tips in the external auditory canal (EAC). Methods: A case series of 2 patients who presented to the emergency department with a 2-month history of worsening unilateral otalgia and aural fullness on a background of cotton bud use. Results: A combination of clinical, radiological, laboratory and examination under anaesthesia (EUA) findings confirmed the diagnosis of NOE with temporal bone osteomyelitis. Removal of the cotton bud FB from the EAC was followed by intravenous and topical quinolone antibiotics for 6 weeks. One patient required a SOMI (sternal occipital mandibular immobiliser) brace for atlantoaxial instability due to the extent of disease. Conclusion: NOE requires a high index of clinical suspicion in patients who use off-label cotton buds or Q-tips in the EAC.