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Systematic review of the diagnosis and management of necrotising otitis externa: Highlighting the need for high-quality research

Lookup NU author(s): Hassan Mohammed

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 2023 The Authors. Clinical Otolaryngology published by John Wiley & Sons Ltd.Objectives: To present a systematic review and critical analysis of clinical studies for necrotising otitis externa (NOE), with the aim of informing best practice for diagnosis and management. Design: Medline, Embase, Cochrane Library and Web of Science were searched from database inception until 30 April 2021 for all clinical articles on NOE. The review was registered on PROSPERO (ID: CRD42020128957) and conducted in accordance with PRISMA guidelines. Results: Seventy articles, including 2274 patients were included in the final synthesis. Seventy-three percent were retrospective case series; the remainder were of low methodological quality. Case definitions varied widely. Median patient age was 69.2 years; 68% were male, 84% had diabetes and 10% had no reported immunosuppressive risk factor. Otalgia was almost universal (96%), with granulation (69%) and oedema (76%) the commonest signs reported. Pseudomonas aeruginosa was isolated in 62%, but a range of bacterial and fungal pathogens were reported and 14% grew no organism. Optimal imaging modality for diagnosis or follow-up was unclear. Median antimicrobial therapy duration was 7.2 weeks, with no definitive evidence for optimal regimens. Twenty-one percent had surgery with widely variable timing, indication, or procedure. One-year disease-specific mortality was 2%; treatment failure and relapse rates were 22% and 7%, respectively. Conclusion: There is a lack of robust, high-quality data to support best practice for diagnosis and management for this neglected condition. A minimum set of reporting requirements is proposed for future studies. A consensus case definition is urgently needed to facilitate high-quality research.

Publication metadata

Author(s): Takata J, Hopkins M, Alexander V, Bannister O, Dalton L, Harrison L, Groves E, Kanona H, Jones GL, Mohammed H, Andersson MI, Hodgson SH

Publication type: Review

Publication status: Published

Journal: Clinical Otolaryngology

Year: 2023

Volume: 48

Issue: 3

Pages: 381-394

Print publication date: 01/05/2023

Online publication date: 09/02/2023

Acceptance date: 28/01/2023

ISSN (print): 1749-4478

ISSN (electronic): 1749-4486

Publisher: John Wiley and Sons Inc

URL: https://doi.org/10.1111/coa.14041

DOI: 10.1111/coa.14041

PubMed id: 36759416

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