Acute otitis externa: consensus definition, diagnostic criteria and core outcome set development.

Smith, Matthew E; Hardman, John C; Mehta, Nishchay; Jones, Gareth H; Mandavia, Rishi; Anderson, Caroline; Khan, Maha; Abdelaziz, Aula; Al-Dulaimy, Bakir; Amin, Nikul; Anmolsingh, Rajesh; Anwar, Bilal; Bance, Manohar; Belfield, Katherine; Bhutta, Mahmood; Buchanan, Ruaridh; Chandrasekharan, Deepak; Chu, Michael; Chundu, Srikanth; Conroy, Katherine; Crundwell, Gemma; Daniel, Mat; Daniels, Jessica; De, Sujata; Dobbs, Sian; Doshi, Jayesh; Farr, Matthew; Ferdous, Tanjinah; Fragkouli, Eleni; Freeman, Simon; Ghosh, Samit; Gosnell, Emma; Hannan, S Alam; Heward, Elliot; Javed, Faisal; John, Deepa; Nicholls, Helen; Kasbekar, Anand V; Khan, Haroon; Khan, Hammad; Khwaja, Sadie; Kotecha, Bhik; Krishnan, Madhankumar; Kumar, Nirmal; Lamb, Tamara; Lancer, Hannah; Manjaly, Joseph G; Martinez Del Pero, Marcos; McClenaghan, Fiona; Milinis, Kristijonas; Mistry, Nina; Mohammed, Hassan; Morris, Elizabeth; Morris-Jones, Stephen; Padee, Jessica; Pal, Surojit; Patel, Sanjay; Pericleous, Agamemnon; Qayyum, Asad; Rouhani, Maral; Saeed, Haroon; Santhiyapillai, Mirusanthan; Seymour, Kay; Sharma, Sunil; Siau, Richard; Singh, Arvind; Stapleton, Emma; Stephenson, Kate; Stynes, Gill; Subramanian, Bharathi; Summerfield, Neil; Swords, Chloe; Trinidade, Aaron; Tse, Antonia; Twumasi, Emmanuel; Ubhi, Harmony; Unadkat, Samit; Vijendren, Ananth; Wasson, Joe; Watson, Glen; Williams, Glennis; Wilson, Janet; Yao, Alexander; Youssef, Ahmed; Lloyd, Simon K W; Tysome, James R

Author

Smith, Matthew E
Hardman, John C
Mehta, Nishchay
Jones, Gareth H
Mandavia, Rishi
Anderson, Caroline
Khan, Maha
Abdelaziz, Aula
Al-Dulaimy, Bakir
Amin, Nikul

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Publication date

2021-05-14

Subject

Ear, Nose and Throat

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Abstract

Objective: 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. Study design: COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. Setting: Stakeholders from the United Kingdom. Subjects and methods: 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. Results: 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'. Conclusion: 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.

Citation

Smith ME, Hardman JC, Mehta N, Jones GH, Mandavia R, Anderson C, Khan M, Abdelaziz A, Al-Dulaimy B, Amin N, Anmolsingh R, Anwar B, Bance M, Belfield K, Bhutta M, Buchanan R, Chandrasekharan D, Chu M, Chundu S, Conroy K, Crundwell G, Daniel M, Daniels J, De S, Dobbs S, Doshi J, Farr M, Ferdous T, Fragkouli E, Freeman S, Ghosh S, Gosnell E, Hannan SA, Heward E, Javed F, John D, Nicholls H, Kasbekar AV, Khan H, Khan H, Khwaja S, Kotecha B, Krishnan M, Kumar N, Lamb T, Lancer H, Manjaly JG, Martinez Del Pero M, McClenaghan F, Milinis K, Mistry N, Mohammed H, Morris E, Morris-Jones S, Padee J, Pal S, Patel S, Pericleous A, Qayyum A, Rouhani M, Saeed H, Santhiyapillai M, Seymour K, Sharma S, Siau R, Singh A, Stapleton E, Stephenson K, Stynes G, Subramanian B, Summerfield N, Swords C, Trinidade A, Tse A, Twumasi E, Ubhi H, Unadkat S, Vijendren A, Wasson J, Watson G, Williams G, Wilson J, Yao A, Youssef A, Lloyd SKW, Tysome JR; INTEGRATE (The UK ENT Trainee Research Network). Acute otitis externa: Consensus definition, diagnostic criteria and core outcome set development. PLoS One. 2021 May 14;16(5):e0251395. doi: 10.1371/journal.pone.0251395

Type

Article