Emerging themes in necrotising otitis externa: a scoping review of the literature from 2011 to 2020 and recommendations for future research

Stapleton, Emma; Watson, Glen

doi:10.1017/s0022215121003030

Cited by 7 publications

(13 citation statements)

References 63 publications

(146 reference statements)

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“…This had negative repercussions on patients' overall health associated with weight loss, anhedonia and difficulties with diabetic control, putting patients at risk of additional co-morbidities. 24,25 This emphasises the importance of involving multidisciplinary teams in the care of necrotising otitis externa patients, 18 including pain, dietetics and endocrinology teams.…”

Section: Discussionmentioning

confidence: 99%

“…17 Although pain is a key feature of necrotising otitis externa, analgesia features in a minority of published treatment protocols. 18…”

Section: Introductionmentioning

confidence: 99%

“…17 Although pain is a key feature of necrotising otitis externa, analgesia features in a minority of published treatment protocols. 18 No previous publication has ever explored the patient's experience of necrotising otitis externa. It is essential to understand the patient's journey, and to consider the impact that this conditionwith such severe symptoms, potentially life-threatening consequences and prolonged treatmentshas on their life and well-being.…”

Section: Introductionmentioning

confidence: 99%

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Patients’ experience of necrotising otitis externa: a qualitative study

2022

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Background Necrotising otitis externa is a serious infective condition. Patients are typically frail, diagnostic delay is common and severe pain is a key feature. This study aimed to qualitatively analyse patient-centred data to identify key themes in the patient's experience. Methods Open-ended questionnaires were sent to 28 patients. Responses were qualitatively analysed using a grounded theory approach. Iterative cycles were used to develop codes using a constant comparison technique. Emerging categories were refined to identify core themes. Results Four main themes emerged: severe pain, mental health, quality of life and diagnostic delays. Conclusion This is the first study to explore patients’ perspectives in necrotising otitis externa. It indicates a need to raise awareness of necrotising otitis externa, and to improve symptom management, pain control and quality of life. This valuable information can be used to identify research priorities, guide service improvements, improve clinical care and feed into the development of a Core Outcome Set for necrotising otitis externa.

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Section: Discussionmentioning

confidence: 99%

“…17 Although pain is a key feature of necrotising otitis externa, analgesia features in a minority of published treatment protocols. 18…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patients’ experience of necrotising otitis externa: a qualitative study

2022

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“…Necrotising otitis externa is a rare infective condition that elicits interest because of its rising incidence, 1 burden on our health services 2 and its potentially fatal complications. 3 No universally recognised diagnostic criteria for necrotising otitis externa exist, 4 and there is no level 1, 2 or 3 evidence for its diagnosis, investigation, management or monitoring. 4 Necrotising otitis externa tends to present at a late stage of the disease 3 and can have a profound negative impact on patients' quality of life.…”

Section: Introductionmentioning

confidence: 99%

Immunosuppression, infection, and epidermal compromise: an aetiological triad for necrotising otitis externa that highlights potential modifiable risk factors

Bisbinas

Stapleton

2022

J. Laryngol. Otol.

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Objective A key clinical feature of necrotising otitis externa is granulation tissue arising from the ear canal, representing epidermal compromise. The aim of this work was to explore the role of epidermal compromise in the aetiology of necrotising otitis externa. Method A structured risk factor history was taken from 54 patients diagnosed with necrotising otitis externa between 2017 and 2022. Primary care records were also reviewed. Results A total of 94 per cent of patients reported incidents of potential epidermal compromise preceding severe pain onset, including a 35 per cent incidence of ear syringing. A total of 94 per cent of patients were immunosuppressed, including 78 per cent with diabetes. All patients had medical co-morbidities. Conclusion This study proposed an aetiological triad for necrotising otitis externa: immunosuppression, infection and epidermal compromise. Epidermal compromise is a potentially modifiable risk factor for necrotising otitis externa. Meticulous primary ear care for older adult, diabetic and immunosuppressed patients is recommended. These populations should never undergo ear syringing and should avoid ear canal trauma and prolonged exposure to moisture.

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“…Necrotising otitis externa, epistaxis education and aerosol generation in coughing Edward W Fisher and Jonathan Fishman, Editors Necrotising otitis externa (previously 'malignant otitis externa') has been the topic of several articles in The Journal of Laryngology & Otology in recent years, [1][2][3] and in other ENT journals, 4 as incidence seems to be increasing for a variety of reasons. Patients are usually older adults, diabetic or may have other reasons for immunosuppression, with severe 'deep' ear pain being a key feature and diagnostic delay all too common.…”

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confidence: 99%