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

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. COS deve...

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Published in:	PloS one Vol. 16; no. 5; p. e0251395
Main Authors:	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.
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 14.05.2021 Public Library of Science (PLoS)
Subjects:	Best practice Biology and Life Sciences Care and treatment Children Clinical trials Computer and Information Sciences Criteria Data analysis Diagnosis Ear Ear canal Editing Education Health care Health education Heterogeneity Hospitals Inflammation Medical diagnosis Medicine and Health Sciences Methodology Otitis Otitis externa People and Places Reviews Smith, John C Surgery United Kingdom United Kingdom > UK
ISSN:	1932-6203, 1932-6203
Online Access:	Get full text
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Summary:	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. COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. Stakeholders from the United Kingdom. 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. 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'. 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Competing Interests: The authors have declared that no competing interests exist. The complete membership of the author group can be listed in the Acknowledgments.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0251395