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

Wieland, Lisa S. and Smith, Matthew E. and Hardman, John C. and Mehta, Nishchay and Jones, Gareth H. and Mandavia, Rishi and Anderson, Caroline and Khan, Maha and Abdelaziz, Aula and Al-Dulaimy, Bakir and Amin, Nikul and Anmolsingh, Rajesh and Anwar, Bilal and Bance, Manohar and Belfield, Katherine and Bhutta, Mahmood and Buchanan, Ruaridh and Chandrasekharan, Deepak and Chu, Michael and Chundu, Srikanth and Conroy, Katherine and Crundwell, Gemma and Daniel, Mat and Daniels, Jessica and De, Sujata and Dobbs, Sian and Doshi, Jayesh and Farr, Matthew and Ferdous, Tanjinah and Fragkouli, Eleni and Freeman, Simon and Ghosh, Samit and Gosnell, Emma and Hannan, S. Alam and Heward, Elliot and Javed, Faisal and John, Deepa and Nicholls, Helen and Kasbekar, Anand V. and Khan, Haroon and Khan, Hammad and Khwaja, Sadie and Kotecha, Bhik and Krishnan, Madhankumar and Kumar, Nirmal and Lamb, Tamara and Lancer, Hannah and Manjaly, Joseph G. and Martinez Del Pero, Marcos and McClenaghan, Fiona and Milinis, Kristijonas and Mistry, Nina and Mohammed, Hassan and Morris, Elizabeth and Morris-Jones, Stephen and Padee, Jessica and Pal, Surojit and Patel, Sanjay and Pericleous, Agamemnon and Qayyum, Asad and Rouhani, Maral and Saeed, Haroon and Santhiyapillai, Mirusanthan and Seymour, Kay and Sharma, Sunil and Siau, Richard and Singh, Arvind and Stapleton, Emma and Stephenson, Kate and Stynes, Gill and Subramanian, Bharathi and Summerfield, Neil and Swords, Chloe and Trinidade, Aaron and Tse, Antonia and Twumasi, Emmanuel and Ubhi, Harmony and Unadkat, Samit and Vijendren, Ananth and Wasson, Joe and Watson, Glen and Williams, Glennis and Wilson, Janet and Yao, Alexander and Youssef, Ahmed and Lloyd, Simon K. W. and Tysome, James R. (2021) Acute otitis externa: Consensus definition, diagnostic criteria and core outcome set development. PLOS ONE, 16 (5). e0251395. ISSN 1932-6203

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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.

Item Type: Journal Article
Keywords: Steering, External otitis, Pain, Ears, Inflammation, Nurses, Quality of life, Taxonomy
Faculty: Faculty of Science & Engineering
Depositing User: Lisa Blanshard
Date Deposited: 10 Jun 2021 10:54
Last Modified: 09 Sep 2021 18:50

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