INTRODUCTION Necrotising otitis externa (NOE) is a severe, life-Threatening infection. Epidemiological data demonstrates a dramatic rise in reported cases in England 2002-17. Reasons for this remain elusive. METHODS A quantitative descriptive study was undertaken using epidemiological data from the Hospital Episode Statistics database. Cases 2002 17 were compiled and analysed. Four potential theories were explored to explain the rise in incidence. RESULTS 7,327 NOE cases were reported within the 16-year period. Annual NOE incidence increased 1142% within the 16-year period, from 123 recorded cases in 2002 to 1405 cases in 2017. This correlates with an increasing prevalence of diabetes, ageing population, and likely increased physician awareness of NOE. There is insufficient evidence to support antibiotic resistance as a significant associated factor. CONCLUSIONS Correlation does not imply causation. It is likely that a combination of factors is contributing to the rise in NOE incidence, including increased physician recognition, diagnosis and coding.