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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. Acute otitis externa: Consensus definition, diagnostic criteria and core outcome set development. PLoS One 2021; 16:e0251395. [PMID: 33989313 PMCID: PMC8121300 DOI: 10.1371/journal.pone.0251395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/25/2021] [Indexed: 11/18/2022] Open
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.
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Affiliation(s)
| | - John C Hardman
- The Royal Marsden Hospital London, London, United Kingdom
| | - Nishchay Mehta
- Royal National ENT Hospital London, London, United Kingdom
| | - Gareth H Jones
- Aintree University Hospitals Liverpool, Liverpool, United Kingdom
| | - Rishi Mandavia
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Maha Khan
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Nikul Amin
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Bilal Anwar
- Salford Royal Hospital, Salford, United Kingdom
| | - Manohar Bance
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Katherine Belfield
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Mahmood Bhutta
- Brighton Sussex University Hospitals, Brighton, United Kingdom
| | | | | | - Michael Chu
- Health Education North West, Manchester, United Kingdom
| | | | - Katherine Conroy
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Gemma Crundwell
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Mat Daniel
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Jessica Daniels
- Tameside and Glossop NHS Integrated Care Trust, Ashton-under-Lyne, United Kingdom
| | - Sujata De
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Sian Dobbs
- Health Education North West, Manchester, United Kingdom
| | - Jayesh Doshi
- Heartlands Hospital Birmingham, Birmingham, United Kingdom
| | - Matthew Farr
- University of Sheffield, Sheffield, United Kingdom
| | - Tanjinah Ferdous
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Eleni Fragkouli
- Oxford University Hospitals Foundation Trust, Oxford, United Kingdom
| | | | - Samit Ghosh
- Pennine Acute Trust, Manchester, United Kingdom
| | - Emma Gosnell
- Royal Bolton Hospital, Farnworth, United Kingdom
| | - S Alam Hannan
- Royal National ENT Hospital London, London, United Kingdom
| | - Elliot Heward
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Faisal Javed
- Heartlands Hospital Birmingham, Birmingham, United Kingdom
| | - Deepa John
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Anand V Kasbekar
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Haroon Khan
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Hammad Khan
- Royal Preston Hospital, Fulwood, United Kingdom
| | - Sadie Khwaja
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Bhik Kotecha
- Nuffield Health Brentwood Hospital, Brentwood, United Kingdom
| | | | - Nirmal Kumar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
| | - Tamara Lamb
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Hannah Lancer
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | | | | | | | - Kristijonas Milinis
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Nina Mistry
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - Hassan Mohammed
- Newcastle Upon Tyne University Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, United Kingdom
| | - Stephen Morris-Jones
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jessica Padee
- University of Manchester, Manchester, United Kingdom
| | - Surojit Pal
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - Sanjay Patel
- Aintree University Hospitals Liverpool, Liverpool, United Kingdom
| | | | - Asad Qayyum
- North West Anglia NHS Foundation Trust, Peterborough, United Kingdom
| | - Maral Rouhani
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Haroon Saeed
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | - Kay Seymour
- Barts Health NHS Trust, London, United Kingdom
| | - Sunil Sharma
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Richard Siau
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Arvind Singh
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - Emma Stapleton
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | - Gill Stynes
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | - Neil Summerfield
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | - Aaron Trinidade
- Southend University Hospital NHS Foundation Trust, Southend-on-Sea, United Kingdom
| | - Antonia Tse
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Emmanuel Twumasi
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Harmony Ubhi
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - Samit Unadkat
- Royal National ENT Hospital London, London, United Kingdom
| | | | - Joe Wasson
- East Kent Hospitals NHS Foundation Trust, Canterbury, United Kingdom
| | - Glen Watson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Janet Wilson
- Newcastle Upon Tyne University Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | | | - Ahmed Youssef
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Simon K W Lloyd
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Thompson L, Kowalczyk W, Golub S, Davis A, Lemann E, Piehl J, Rita N, Moss L, Davis A, Boseck J, Berry K, Koehn E, Meyer B, Gelder B, Davis A, Nogin R, Moss L, Drapeau C, Malm S, Davis A, Lemann E, Koehn E, Drapeau C, Malm S, Boseck J, Armstrong L, Glidewell R, Orr W, Mears G. Grand Rounds. Arch Clin Neuropsychol 2012. [DOI: 10.1093/arclin/acs070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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