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Tsikoudas A et al. - Factors that have been implicated are repeated trauma of the external canal and vascular abnormalities. Although people with diabetes appear to have a higher incidence of BNOE, the true incidence is not clear. Other possible factors include syphilis, arterial embolus, and neurotrophic disturbances.2The usual presentation of BNOE includes chronic infective otorrhea with underlying avascular necrosis of the tympanic plate and the development of a sequestrum.

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