1
|
Morris S, Owens D, Cserzo D. Learning needs of junior doctors in otolaryngology: a qualitative study. J Laryngol Otol 2024; 138:592-600. [PMID: 38230502 DOI: 10.1017/s0022215124000100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVES There is concern that junior doctors are not prepared for their post-graduate attachments in ENT. The aims of this study were to capture the learning priorities of those in the ENT first on-call role and facilitate further educational opportunities to address these needs. METHOD Semi-structured interviews were undertaken to explore the learning needs of junior doctors with seven junior and two senior ENT clinicians. RESULTS The thematic analysis generated three themes: the role of the ENT Junior; the perceived, expressed and prescribed learning needs; and attitudes towards future learning. These themes explored the misalignment between undergraduate training and post-graduate expectations, the lack of competence in ENT practical skills and the need for focused ENT training prior to commencing on-call shifts. CONCLUSION All interviewees identified the need for greater experience in practical interventional skills prior to their ENT attachments and expressed interest towards a standardised, bootcamp-style induction with simulated emergency experience.
Collapse
Affiliation(s)
- Simon Morris
- Department of ENT, Glangwili General Hospital, Carmarthen, Wales, UK
| | - David Owens
- Department of ENT, University Hospital Wales, Cardiff, Wales, UK
| | - Dorottya Cserzo
- School of Social Sciences, Cardiff University, Cardiff, Wales, UK
| |
Collapse
|
2
|
Di Traglia R, Tudor-Green B, Muzaffar J, Borsetto D, Smith ME. Antibiotics versus non-antibiotic treatments for acute otitis externa: A systematic review and meta-analysis. Clin Otolaryngol 2023; 48:841-862. [PMID: 37550850 DOI: 10.1111/coa.14084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/03/2023] [Accepted: 07/02/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Otitis externa is a condition causing inflammation of the outer ear canal, which presents with itching, discharge and pain. Most cases of acute otitis externa are caused by bacterial infection and are thus treated with antibiotics. This systematic review and meta-analysis of randomised controlled trials aims to assess the effectiveness of topical non-antibiotic treatments compared to topical antibiotic treatment for the treatment of acute otitis externa. METHODS Systematic review and meta-analysis databases searched: Cochrane Library including ClinicalTrials.gov; MEDLINE; World Health Organisation International Clinical Trials Registry Platform and Web of Science to identify randomised clinical trials evaluating topical antibiotics and topical non-antibiotic agents in adults and children with acute otitis externa. Non-antibiotic therapeutics for comparison with topical antibiotics included antiseptics, steroids, non-pharmaceuticals and astringents. RESULTS Seventeen trials were eligible for inclusion, with 10 combined in meta-analysis. Data could be pooled comparing antiseptic and steroid monotherapies with topical antibiotic agents. There were no significant differences in cure rates in any pairwise comparisons. Individually, the majority of studies favoured topical antiseptics or steroids over antibiotics, however these differences were not significant when pooled in meta-analysis. CONCLUSION Antiseptic, steroid and antibiotic monotherapies are all effective for the management of acute otitis externa. There is insufficient evidence to suggest that topical antiseptic or steroid agents are superior or inferior to topical antibiotics.
Collapse
Affiliation(s)
- Rosalind Di Traglia
- School of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Cambridge Ear Institute, Cambridge, UK
| | - Ben Tudor-Green
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jameel Muzaffar
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Matthew E Smith
- School of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Cambridge Ear Institute, Cambridge, UK
| |
Collapse
|
3
|
Mather MW, Mohammed H, Wilson JA. Improving patient care pathways in otitis externa. Fam Pract 2022; 39:971-973. [PMID: 35022709 DOI: 10.1093/fampra/cmab181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Referrals for otitis externa (OE) have dramatically increased but the reasons for this remain unclear. We aim to characterize management of patients both pre- and post-referral to identify areas of improvement at the primary-secondary care interface. METHODS Questionnaire study from consultant-led research clinic specifically set up to prospectively analyse OE referrals at a tertiary referral centre for Otolaryngology. RESULTS Sixty-two patients were included; 63% female, median age 57 years. One was excluded (clinically not OE). Most patients had multiple primary care visits before referral (average 4 GP; 2 practice nurse). Sixty per cent had received oral antibiotics (16% multiple classes). Eighteen per cent had never had ear drops. Thirty-nine per cent were not advised to keep ears dry. Twenty-one per cent had dermatitis; 13% contact allergy, 30% systemic allergy, 5% diabetes. Less than 10% had narrow canals. Thirty-six per cent had active discharge but <7% needed a wick. Approximately 75% appear suitable for community aural care clinics. CONCLUSIONS OE occurs most commonly in female patients, often with associated risk factors. Patients often consult primary care several times prior to referral. Lifestyle advice and ototopical drops are frequently overlooked; instead, often inappropriately treated with oral antibiotics. Most ears were anatomically normal, and community aural care clinics may have a role in more timely and accessible treatment.
Collapse
Affiliation(s)
- Michael W Mather
- Department of Otolaryngology, Freeman Hospital, High Heaton, Newcastle-upon-Tyne NE7 7DN, UK
| | - Hassan Mohammed
- Department of Otolaryngology, Freeman Hospital, High Heaton, Newcastle-upon-Tyne NE7 7DN, UK
| | - Janet A Wilson
- Department of Otolaryngology, Freeman Hospital, High Heaton, Newcastle-upon-Tyne NE7 7DN, UK
| |
Collapse
|
4
|
Otitis externa - what is the problem with getting it right? A mixed-methods study in primary and secondary care. The Journal of Laryngology & Otology 2021; 136:486-491. [PMID: 34819190 DOI: 10.1017/s0022215121003649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
5
|
|
6
|
Mughal Z, Swaminathan R, Al-Deerawi HB, Henney S, Bickerton R. A Systematic Review of Antibiotic Prescription for Acute Otitis Externa. Cureus 2021; 13:e14149. [PMID: 33927951 PMCID: PMC8076578 DOI: 10.7759/cureus.14149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There is a perception among ear, nose, and throat (ENT) surgeons that oral antibiotics are over-prescribed for acute otitis externa (AOE), and the potential for topical therapy as first-line treatment is not fully realized in primary care. We evaluated the prescription rate of topical and oral antibiotics for AOE in primary care and in patients referred to the ENT emergency clinic. METHODS A systematic review was performed by searching the MEDLINE, Embase, PubMed, and Google Scholar databases between January 1990 and October 2020. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool. The outcome measures were the rate of topical and oral antibiotic prescriptions for AOE by primary care practitioners and the rate of oral antibiotic prescriptions that were not indicated. RESULTS Seven studies met the inclusion criteria. The overall quality of evidence was moderate. The rate of topical antibiotic prescriptions was between 77% and 95%, and oral antibiotics varied between 6% and 30% in patients that were managed only in primary care. Patients that were referred to an ENT emergency clinic had initially been treated by primary care practitioners with topical antibiotics in 14%-60% of cases and oral antibiotics in 16%-17%. The most commonly prescribed oral antibiotics were Amoxicillin and Co-amoxiclav (amoxicillin/clavulanic acid). No study had comprehensively reviewed the indication for oral antibiotics. CONCLUSION The rate of topical antibiotic prescriptions for AOE was high in primary care; however, the rate was frequently suboptimal in patients attending the ENT emergency clinic. Although the rate of oral antibiotic prescriptions was relatively low, the choice of antibiotic for empirical treatment frequently did not cover the typical bacteria in AOE. There is a need for improvement in primary care prescribing of topical therapy prior to referral to the ENT emergency clinic.
Collapse
|
7
|
Shahidi S, Nassimizadeh A, Coulson C. Treating twenty-five cases of chronic resistant otitis externa with fluticasone propionate (Flixonase ® ): A case series. Clin Otolaryngol 2020; 46:75-78. [PMID: 32770842 DOI: 10.1111/coa.13628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022]
|
8
|
A survey of ENT undergraduate teaching in the UK. The Journal of Laryngology & Otology 2020; 134:553-557. [DOI: 10.1017/s0022215120000936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundENT presentations are prevalent in clinical practice but feature little in undergraduate curricula. Consequently, most medical graduates are not confident managing common ENT conditions. In 2014, the first evidence-based ENT undergraduate curriculum was published to guide medical schools.ObjectiveTo assess the extent that current UK medical school learning outcomes correlate with the syllabus of the ENT undergraduate curriculum.MethodTwo students from each participating medical school independently reviewed all ENT-related curriculum documents to determine whether learning outcomes from the suggested curriculum were met.ResultsSixteen of 34 curricula were reviewed. Only a minority of medical schools delivered teaching on laryngectomy or tracheostomy, nasal packing or cautery, and ENT medications or surgical procedures.ConclusionThere is wide variability in ENT undergraduate education in UK medical schools. Careful consideration of which topics are prioritised, and the teaching modalities utilised, is essential. In addition, ENT learning opportunities for undergraduates outside of the medical school curriculum should be augmented.
Collapse
|
9
|
Treatment of Mixed Otitis Externa Using Ceftazidime Powder and Topical Miconazole Versus Topical Miconazole Only. Jundishapur J Microbiol 2018. [DOI: 10.5812/jjm.79887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
10
|
Gurov AV, Kriukov AI, Kunelskaya VY, Isotova GN, Shadrin GB, Luchsheva YV, Yakimov VO, Garg A, Akku SP, Gupta N. Evaluation of the Efficacy and Tolerability of Oral Ciprofloxacin used in the Comprehensive Treatment of External Bacterial Otitis: An Observational Prospective Study. Int Arch Otorhinolaryngol 2017; 21:329-335. [PMID: 29018494 PMCID: PMC5629078 DOI: 10.1055/s-0037-1598648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/28/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction
Otitis Externa is common ear infection with a prevalence of 1%.
Objective
The objective of this study is to evaluate the clinical and microbiological efficacy and safety profile with oral ciprofloxacin in the external bacterial otitis (EBO) management.
Methods
This is a prospective observational study conducted with EBO outpatients referred to the otorhinolaryngology center in Moscow between March and August 2013. Our study included patients from two cohorts, acute external bacterial otitis (AEBO) - Group 1 - and exacerbation of chronic otitis externa (CEBO) - Group 2. We administered Ciprofloxacin 500 mg twice daily with standard topical EBO treatment for up to 10 days. Patients underwent evaluation on study visit days 1, 3, 5, and 10 for the severity. Bacteriological examination of ear canal cultures took place on Day 1 and Day 10.
Results
We collected data from 60 EBO outpatients (AEBO:
N
= 30 and CEBO:
N
= 30). Swimming was the major risk factor associated with the disease in addition to the most common pathogenic organisms -
Staphylococcus aureus
and
Pseudomonas aeruginosa
. was We attained complete resolution of the inflammatory process in 28 (93%) and 27 (90%) patients in the AEBO and CEBO group, respectively. We confirmed this by microbiological test with almost complete eradication of the causative organisms. Overall, we observed good positive dynamics of ear canal with no major side effects.
Conclusion
We found that Ciprofloxacin 500 mg, when administered orally twice daily for 7 to 10 days in otitis externa patients is clinically and microbiologically effective and comparatively safer than other antimicrobials.
Collapse
Affiliation(s)
- Alexander Vladimirovich Gurov
- The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute, Moscow Department of Healthcare, Moscow, Russian Federation
| | - Andrey Ivanovich Kriukov
- The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute, Moscow Department of Healthcare, Moscow, Russian Federation
| | - Vera Yakovlevna Kunelskaya
- The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute, Moscow Department of Healthcare, Moscow, Russian Federation
| | - Galina Nikolaevna Isotova
- The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute, Moscow Department of Healthcare, Moscow, Russian Federation
| | - Georgiy Borisovich Shadrin
- The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute, Moscow Department of Healthcare, Moscow, Russian Federation
| | - Yuliya Vladislavovna Luchsheva
- The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute, Moscow Department of Healthcare, Moscow, Russian Federation
| | - Vladislav Olegovich Yakimov
- The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute, Moscow Department of Healthcare, Moscow, Russian Federation
| | - Amit Garg
- Emerging Markets, Global Medical Affairs, Dr. Reddy's Laboratories Ltd., Hyderabad, Telangana, India
| | - Shyam Prasad Akku
- Emerging Markets, Global Medical Affairs, Dr. Reddy's Laboratories Ltd., Hyderabad, Telangana, India
| | - Namita Gupta
- Global Medical Affairs, Dr. Reddy's Laboratories Ltd., Hyderabad, Telangana, India
| |
Collapse
|
11
|
Assessment of the Antimicrobial Activity of Algae Extracts on Bacteria Responsible of External Otitis. Mar Drugs 2015; 13:6440-52. [PMID: 26492256 PMCID: PMC4626699 DOI: 10.3390/md13106440] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/30/2015] [Accepted: 10/08/2015] [Indexed: 01/23/2023] Open
Abstract
External otitis is a diffuse inflammation around the external auditory canal and auricle, which is often occurred by microbial infection. This disease is generally treated using antibiotics, but the frequent occurrence of antibiotic resistance requires the development of new antibiotic agents. In this context, unexplored bioactive natural candidates could be a chance for the production of targeted drugs provided with antimicrobial activity. In this paper, microbial pathogens were isolated from patients with external otitis using ear swabs for over one year, and the antimicrobial activity of the two methanol extracts from selected marine (Dunaliella salina) and freshwater (Pseudokirchneriella subcapitata) microalgae was tested on the isolated pathogens. Totally, 114 bacterial and 11 fungal strains were isolated, of which Staphylococcus spp. (28.8%) and Pseudomonas aeruginosa (P. aeruginosa) (24.8%) were the major pathogens. Only three Staphylococcus aureus (S. aureus) strains and 11 coagulase-negative Staphylococci showed resistance to methicillin. The two algal extracts showed interesting antimicrobial properties, which mostly inhibited the growth of isolated S. aureus, P. aeruginosa, Escherichia coli, and Klebsiella spp. with MICs range of 1.4 × 109 to 2.2 × 1010 cells/mL. These results suggest that the two algae have potential as resources for the development of antimicrobial agents.
Collapse
|
12
|
Investigation of demodex species frequency in patients with a persistent itchy ear canal treated with a local steroid. The Journal of Laryngology & Otology 2014; 128:698-701. [PMID: 25033419 DOI: 10.1017/s0022215114001510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the frequency of demodex species in the external acoustic meatus in patients with an itchy ear canal. METHODS Patients were assigned to one of three groups. Group one consisted of 54 patients with an itchy ear canal who were using a local agent, while group two was composed of 51 patients with an itchy ear canal who were not using a local agent. Group three consisted of 50 healthy individuals without an itchy ear canal. RESULTS Demodex species test results were positive in nine (5.8 per cent) of the cases. Six of these positive cases were in group one, two in group two and one in group three. The frequency of demodex species in the external acoustic meatus was similar between those patients with an itchy ear canal who did not use a local agent and the healthy individuals (p = 0.571), but it was significantly higher in those using a local steroid compared with those not using a local agent (p = 0.046). CONCLUSION Although demodex species was not significantly higher in patients with an itchy ear canal compared with the control group, use of a local steroid increased the parasite frequency in the external ear canal of affected patients.
Collapse
|
13
|
Gollnick I, Frehiwot M, Krause EM, Schaller S, Limpert E, Strauß G, Lipp T, Scherz M, Injac Z. [Interdisciplinary teleconsultation: first practical experiences with 100 patients]. HNO 2014; 61:495-503. [PMID: 23619814 DOI: 10.1007/s00106-012-2668-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED PROBLEM DEFINITION: Increasing specialization can be observed in the various medical fields and as a consequence there is little professional exchange between ear nose and throat (ENT) specialists and general practitioners. At the same time there has been significant technological development in telemedicine over the last 5 years; however, this potential is not being sufficiently exploited. The objective of this project is to implement a practicable solution for teleconsulation between ENT specialists and general practitioners. MATERIALS AND METHODS The connection is based on a secure broadband internet connection, the corresponding server structure and a video endoscopic system. In the period from 01 January 2011 to 30 June 2012 (18 months) a total of 102 patients were included in the study in which 4 general practitioners and 5 ENT specialists participated. The protocol comprised the following parameters: indications and typical questions, number of patients presenting to the ENT specialist due to the available teleconsultation service (CBO), number of patients referred to the ENT specialist after teleconsultation (CIO), assessment of the quality of the additional expert opinion (LOQ GP), assessment of the accuracy of the specialist physician tele-diagnosis (TDS-FA) and assessment of the impact of the expert physician diagnosis on the general medical treatment (COS). RESULTS Teleconsultation was most frequently used for diagnostics on tonsils (37% of the presented cases), the external auditory canal (32%) and the inner nose (15%). Of the patients analyzed were 53.9% presented to the ENT specialist only because the teleconsultation service provided an effortless opportunity and after teleconsultation 40.1% of the patients were referred to the ENT specialist. General practitioners assessed the benefit from the specialist opinion with 64 points. Diagnostic certainty of the specialist opinion, i.e. the validity scale of the diagnosis made, was on average 2.0. In approximately 35.3% of the cases (36 out of 102 patients) participating general practitioners documented a considerable impact of teleconsultation on the diagnosis and/or therapy. CONCLUSIONS Teleconsultation between general practitioners and ENT specialists can provide an advantage in treatment quality and patient comfort. According to the experience gained there is a very low risk of diminishing the professional competency of ENT medicine and the involvement of the expert group in the early project stage allows a greater leeway in project implementation. This could also have an impact on future medical performance specifications. According to the ENT experts involved in the project further applications of teleconsultation are very conceivable.
Collapse
Affiliation(s)
- I Gollnick
- International Reference and Development Centre for Surgical Technology (IRDC) Leipzig, Käthe-Kollwitz-Str. 64, 04109, Leipzig, Deutschland.
| | | | | | | | | | | | | | | | | |
Collapse
|