OBJECTIVE: Evidence for necrotising otitis externa (NOE) diagnosis and management is limited, and outcome reporting is heterogeneous. International best practice guidelines were used to develop consensus diagnostic criteria and a core outcome set (COS).
METHODS: The study was pre-registered on the Core Outcome Measures in Effectiveness Trials (COMET) database. Systematic literature review identified candidate items. Patient-centred items were identified via a qualitative study. Items and their definitions were refined by multidisciplinary stakeholders in a two-round Delphi exercise and subsequent consensus meeting.
RESULTS: The final COS incorporates 36 items within 12 themes: Signs and symptoms; Pain; Advanced Disease Indicators; Complications; Survival; Antibiotic regimes and side effects; Patient comorbidities; Non-antibiotic treatments; Patient compliance; Duration and cessation of treatment; Relapse and readmission; Multidisciplinary team management.Consensus diagnostic criteria include 12 items within 6 themes: Signs and symptoms (oedema, otorrhoea, granulation); Pain (otalgia, nocturnal otalgia); Investigations (microbiology [does not have to be positive], histology [malignancy excluded], positive CT and MRI); Persistent symptoms despite local and/or systemic treatment for at least two weeks; At least one risk factor for impaired immune response; Indicators of advanced disease (not obligatory but mut be reported when present at diagnosis). Stakeholders were unanimous that there is no role for secondary, graded, or optional diagnostic items. The consensus meeting identified themes for future research.
CONCLUSIONS: The adoption of consensus-defined diagnostic criteria and COS facilitates standardised research reporting and robust data synthesis. Inclusion of patient and professional perspectives ensures best practice stakeholder engagement.

To establish consensus definitions for necrotising otitis externa (NOE) to facilitate the diagnosis and exclusion of NOE in clinical practice and expedite future high-quality study of this neglected condition.
The work comprised of a systematic review of the literature, five iterative rounds of consultation via a Delphi process and open discussion within the collaborative. An expert panel analysed the results to produce the final outputs which were shared with and endorsed by national specialty bodies.
Secondary care in the UK.
UK clinical specialists practising in infection, ear nose and throat (ENT) surgery or radiology.
Definitions and statements meeting the following criteria were accepted: (a) minimum of 70% of respondents in agreement or strong agreement with a definition/statement AND (b) <15% of respondents in disagreement or strong disagreement with a definition/statement.
Seventy-four UK clinicians specialising in ENT, Infection and Radiology with a special interest in NOE took part in the work which was undertaken between 2019 and 2021. The minimum response rate for a Round was 76%. Consensus criteria for all proposed case definitions, outcome definitions and consensus statements were met in the fifth round.
This work distills the clinical opinion of a large group of multidisciplinary specialists from across the UK to create practical definitions and statements to support clinical practice and research for NOE. This is the first step in an iterative process. Further work will seek to validate and test these definitions and inform their evolution.

Acute otitis externa (AOE), also known as \'swimmer\'s ear\', is a common acute problem. It is one of the most common ED presentations. Atypical organisms, recalcitrant disease and antibiotic options contribute to making AOE a clinical challenge. There are a number of red flags associated with AOE which require consideration when treating patients with AOE. We discuss an evidence-based approach to management of AOE in the emergency setting, with indications for specialist referral.

Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE.
COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition.
Stakeholders from the United Kingdom.
Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition.
Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was \'diffuse inflammation of the ear canal skin of less than 6 weeks duration\'.
The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life.

The American Academy of Otolaryngology-Head and Neck Surgery has published clinical practice guidelines (CPGs) to guide management of common otolaryngologic (ENT) conditions. While these CPGs have been disseminated within specialty journals, many patients\' first presentation of certain ENT complaints is to primary and acute care settings, including the emergency department (ED). It is less clear whether practice in these settings is concordant with specialty CPGs.
Retrospective cohort study.
A retrospective review of medical records was performed at an academic tertiary care center with ED diagnoses of 1) Bell\'s palsy/facial weakness (BP) or 2) acute otitis externa (AOE) from May 2014-June 2018. Individual chart abstraction was performed for all encounters with these diagnoses for the purpose of assessing providers\' adherence to CPGs.
During the study period, 224 patients were diagnosed with BP and 465 patients were diagnosed with AOE. Of the patients diagnosed with BP, 94% (n = 211/224) were prescribed oral steroids, concordant with guidelines, while 36% of these patients received head computed tomography (CT) scans and 43% received laboratory tests, counter to the guidelines. For those with a diagnosis of AOE, 28.6% received topical antibiotics only as primary treatment (n = 133/465) in accordance with guidelines while systemic antibiotics were prescribed in 42.2% (n = 196/465) discordant with the guidelines and 29.2% received both topical and systemic antibiotics (n = 136/465).
CPGs developed by subspecialty societies provide evidence-based recommendations for the care of patients with particular conditions, but may not be disseminated broadly outside of the specialty. Further research is required to understand the reasons behind divergent management of such conditions.
3 Laryngoscope, 131:1266-1270, 2021.

BACKGROUND: Necrotising otitis externa is a progressive infection of the external auditory canal which extends to affect the temporal bone and adjacent structures. Progression of the disease process can result in serious sequelae, including cranial nerve palsies and death. There is currently no formal published treatment guideline.
OBJECTIVE: This study aimed to integrate current evidence and data from our own retrospective case series in order to develop a guideline to optimise necrotising otitis externa patient management.
METHODS: A retrospective review of necrotising otitis externa cases within NHS Lothian, Scotland, between 2013 and 2018, was performed, along with a PubMed review.
RESULTS: Prevalent presenting signs, symptoms and patient demographic data were established. Furthermore, features of cases associated with adverse outcomes were defined. A key feature of the guideline is defining at-risk patients with initial intensive treatment. Investigations and outcomes are assessed and treatment adjusted appropriately.
CONCLUSIONS: This multi-departmental approach has facilitated the development of a succinct, systematic guideline for the management of necrotising otitis externa. Initial patient outcomes appear promising.

Over 10 years have passed since the Clinical Practice Guideline: Acute Otitis Externa (CPG-AOE) was first published, and it has been several years since its update. We sought to assess clinicians\' adherence as well as referral patterns.
Survey.
A 23-question survey was distributed to regional primary care clinicians evaluating demographic data, perception of the clinical practice guideline (CPG), adherence, and details of specialist referral. Statistical analysis was performed to compare adherence and referral patterns using the Fisher exact test or the χ2 test.
One hundred seventeen clinicians completed the survey. Fifteen respondents (12.8%) had reviewed the CPG. The recommendations with the least reported adherence were pain management (39.1%) and accounting for prior radiotherapy as a modifying factor (43.0%). The recommendations of prescribing ototopical therapy and avoiding systemic antimicrobials in uncomplicated acute otitis externa had adherence of 94.0% and 83.8%, respectively. When analyzed by provider type (e.g., resident, nurse practitioner/physician assistant), there were no significant differences in adherence. No significant differences in adherence were observed based on previous review of the CPG. When reporting frequency of specialist referral, the majority of respondents selected rarely (53.9%). The most favored reason for referral was symptoms >4 weeks (86.3%).
Of the providers who responded, very few had reviewed the CPG-AOE. Despite the added emphasis on pain management in the CPG update, this recommendation had the lowest adherence. Rates of adherence were similar across provider types and did not differ significantly if the CPG was reviewed. Efforts at improved provider education should be considered to increase adherence to the CPG.
NA Laryngoscope, 130:1565-1571, 2020.

To assess the extent of systemic antibiotic use among patients with acute otitis externa (AOE), as well as the impact of an AOE clinical practice guideline publication in 2006.
Interrupted time series study of retrospective data.
Medicaid billing data from 29 states between 2002 and 2010.
Patients with age less than 65 years, continuous Medicaid eligibility for 12 months before AOE diagnosis, and dispensation of antibiotics within 1 day before through 3 days after AOE diagnosis.
The proportion of AOE visits that received systemic antibiotics among all AOE visits that were dispensed any antibiotics, systemic or topical.
We found 682,865 AOE visits that received systemic or topical antibiotics for AOE. The proportion of systemic antibiotic therapy either with or without topical therapy was 43.1% before and 38.3% after AOE guideline publication. There was no significant immediate drop (-0.01; 95%CI, -0.031-0.011) or change in trend (0.002; 95%CI, -0.001-0.004) in the prevalence of systemic antibiotic therapy after guideline publication.
Publication of an AOE clinical guideline did not lead to a decline in systemic antibiotic therapy as initial AOE treatment. Additional efforts will be needed to curb systemic antibiotic treatment for AOE.

暂无摘要。

The American Academy of Otolaryngology--Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the updated Clinical Practice Guideline: Acute Otitis Externa, as a supplement to Otolaryngology-Head and Neck Surgery. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 8 recommendations developed address appropriate diagnosis of acute otitis externa (AOE) and the use of oral and topical antimicrobials and highlight the need for adequate pain relief. An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group.