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Lodhi S, Dodgson K, Dykes M, Vishwanath V, Bazaz R, Mathur S, Watson G, Cartwright K, Pearson A, Wearmouth D, List R, Yates P, Dixon J, Puveendran A, Wilson M, Watson K, Cullinan M, Mentias Y, Capper R, Jewes L, Wallis S, Hamilton D, Adams B, Khalid-Raja M, Faris B, Khan M, Linton S, Abrar R, Owen E, Bisbinas V, Ijaz A, Lau K, Timms S, Bruce J, Stapleton E. Diagnostic criteria and core outcome set development for necrotising otitis externa: the COSNOE Delphi consensus study. J Laryngol Otol 2024:1-8. [PMID: 38644734 DOI: 10.1017/s0022215124000513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
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. CONCLUSION 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.
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Affiliation(s)
- Sirat Lodhi
- Department of Otolaryngology, Manchester Royal Infirmary, UK
| | - Kirsty Dodgson
- Department of Microbiology, Manchester Royal Infirmary, UK
| | - Michael Dykes
- Department of Radiology, Manchester Royal Infirmary, UK
| | | | - Rohit Bazaz
- Department of Microbiology Wythenshawe Hospital, Manchester, UK
| | | | - Glen Watson
- Department of Otolaryngology, Sheffield Teaching Hospitals, UK
| | | | - Amy Pearson
- Department of Otolaryngology, Hull University Teaching Hospitals, UK
| | | | - Richard List
- Department of Radiology, Hull University Teaching Hospitals, UK
| | - Phillip Yates
- Department of Otolaryngology, Newcastle Upon Tyne NHS Hospitals, UK
| | - Joanna Dixon
- Department of Radiology, Newcastle Upon Tyne NHS Hospitals, UK
| | | | | | | | - Milo Cullinan
- Department of Microbiology, Sunderland Royal Hospital, UK
| | | | - Ruth Capper
- Department of Otolaryngology, Doncaster Royal Infirmary, UK
| | - Linda Jewes
- Department of Microbiology, Doncaster Royal Infirmary, UK
| | | | | | | | | | - Barzo Faris
- Department of Microbiology, Stepping Hill Hospital, Stockport, UK
| | - Maha Khan
- Department of Otolaryngology, Manchester Royal Infirmary, UK
| | - Stefan Linton
- Department of Otolaryngology, St John's Hospital, Livingston, UK
| | - Rohma Abrar
- Department of Otolaryngology, Doncaster Royal Infirmary, UK
| | - Eloise Owen
- Department of Otolaryngology, University of Manchester, UK
| | | | - Ali Ijaz
- Department of Otolaryngology, University of Sheffield, UK
| | - Kimberley Lau
- Department of Otolaryngology, Sheffield Teaching Hospitals, UK
| | - Sara Timms
- Department of Otolaryngology, Preston Royal Hospital, UK
| | - Jack Bruce
- Department of Otolaryngology, University of Manchester, UK
| | - Emma Stapleton
- Department of Otolaryngology, Manchester Royal Infirmary, UK
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Lodhi S, Timms S, Stapleton E. A systematic review of antimicrobial treatment regimens and their outcomes in necrotising otitis externa. J Laryngol Otol 2024; 138:120-129. [PMID: 37767726 DOI: 10.1017/s0022215123001664] [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: 09/29/2023]
Abstract
BACKGROUND Necrotising otitis externa is a serious infection with minimal evidence underpinning its management. This review aims to synthesise published evidence of antimicrobial therapies and their outcomes in necrotising otitis externa. METHODS The review was PROSPERO registered (CRD42022353244) and conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses ('PRISMA') guidelines. A robust search strategy filtered 28 manuscripts into the final review. Antimicrobial therapy and clinical outcome data were extracted and analysed. RESULTS Published studies are heterogeneous, with high risk of bias and low certainty. Reporting of outcomes is poor and extremely variable. First-line therapy is most commonly in-patient (95 per cent) empiric fluoroquinolone (68 per cent) delivered intravenously (82 per cent). The lack of granular data and poor outcome reporting mean it is impossible to correlate treatment strategies with clinical outcomes. CONCLUSION Robust, consistent outcome reporting with reference to treatments administered is mandatory, to inform clinical management and optimise future research. Optimal antimicrobial choices and treatment strategies require clarification through prospective clinical trials.
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Affiliation(s)
- Sirat Lodhi
- Department of Otolaryngology, Manchester Royal Infirmary, Oxford Road, Manchester, UK
| | - Sara Timms
- Department of Otolaryngology, Manchester Royal Infirmary, Oxford Road, Manchester, UK
| | - Emma Stapleton
- Department of Otolaryngology, Manchester Royal Infirmary, Oxford Road, Manchester, UK
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