Otitis Externa Research Articles

Surgical consideration and practical difficulty in malignant otitis externa: a systematic review.

This systematic review aims to explore the role of surgery in managing Malignant Otitis Externa (MOE) by analyzing surgical considerations, treatment duration, responses, and patient outcomes. A comprehensive search was conducted across PubMed, Science Direct, Google Scholar, and Cochrane Library databases between 2003 and February 2023. Studies meeting inclusion criteria detailed MOE cases, patient medical profiles, surgical procedures undertaken, and treatment outcomes. Selection criteria emphasized surgical aspects and patient-related outcomes in MOE. Twenty-two articles published from 2006 to 2023, encompassing 901 predominantly male participants, were included. Studies fell into quantitative descriptive (e.g., case series) and non-randomized quantitative categories (e.g., cohort studies). Surgery was primarily performed due to failed conservative treatments, complications like skull base osteomyelitis, and disease progression. Surgical interventions, notably debridement and mastoidectomy (n = 15), were detailed, with varied survival and mortality rates among studies. Prompt identification and effective management are crucial for MOE, a rapidly advancing condition. Surgical intervention emerged as the preferred treatment option for critically affected MOE patients, especially in cases of failed conservative measures, complications, and disease progression.

Bilateral laryngeal paralysis following single‐staged, bilateral total ear canal ablation and lateral bulla osteotomy in a cocker spaniel

AbstractAn 8‐year‐old, spayed, female cocker spaniel was presented for surgical treatment of otitis externa and media/interna that was unresponsive to medical management. Preoperative computed tomography imaging revealed bilateral otitis externa and media/interna. Extensive soft tissue proliferation and mineralisation of the ear canals were present. Both tympanic bullae had lysis and proliferative bony changes. The dog underwent single‐staged, bilateral total ear canal ablation and lateral bulla osteotomies. Following recovery from anaesthesia, inspiratory respiratory distress developed. Visual examination of the larynx documented bilateral laryngeal paralysis. Palliation with unilateral arytenoid lateralisation was declined and despite 9 days of antimicrobials, anti‐inflammatory medication, oxygen therapy and supportive care, inspiratory respiratory distress persisted. The dog was euthanased due to inability to breathe comfortably without supplemental oxygen. Bilateral laryngeal paralysis was considered secondary to iatrogenic surgical trauma to the vagus nerve.

A Prospective Study Investigating the Health Outcomes of Bitches Neutered Prepubertally or Post-Pubertally.

There are scant studies of associations between the pubertal status at neutering and subsequent health outcomes of female dogs. This study examined health data for Labrador and Golden Retriever crossbreed bitches neutered by ovariohysterectomy either before (PrePN, n = 155) or after (PostPN, n = 151) puberty using a prospective study design. Data were extracted from an electronic database containing detailed health records for all bitches. Cruciate ligament disease occurred in significantly more PrePN (n = 11) than PostPN bitches (n = 1; Yates Chi-square = 6.784, D.F. = 1, p = 0.009), and PrePN bitches had lower probabilities of remaining free from osteoarthritis (χ2 = 5.777, D.F. = 1, p = 0.016). Additionally, PrePN bitches were diagnosed with atopic dermatitis (PrePN: 3.9 ± 0.6 years, PostPN: 1.6 ± 0.3 years; Mann-Whitney U test = 90.5, p = 0.008) and perivulval dermatitis (PrePN: 4.7 ± 0.9 years, PostPN: 0.8 ± 0.1 years; Mann-Whitney U test = 40.0, p = 0.002) at significantly older ages and had lower probabilities of remaining free from otitis externa (χ2 = 7.090, D.F. = 1, p = 0.008). No associations were identified between the pubertal status at neutering and the incidence of any urogenital disease, including urinary incontinence, which was diagnosed in a small number of bitches (one PrePN and six PostPN). The results suggest that prepubertal neutering may have a detrimental effect on some future musculoskeletal and immune diseases in bitches of these crossbreeds, providing important information to support neutering policies and to help maintain optimal dog welfare.

When tuberculosis makes you deaf

Tuberculous otomastoiditis is a rare and serious infection that most often occurs in association with pulmonary involvement. It is easy to diagnose when the two pathologies are associated and isolated. We herein report the case of a patient initially hospitalized for Pseudomonas aeruginosa necrotising otitis externa (NOE), which delayed the diagnosis of tuberculous otomastoiditis. The 50-year-old patient was hospitalized for NOE and concurrently presented with pulmonary tuberculosis. NOE was associated with temporal bone lysis with carotid canal involvement. Despite appropriate treatment, NOE evolution was unfavourable. Two months later, the patient underwent a mastoidectomy to evacuate a mastoid abscess. In a deep tissue sample, tuberculosis complex was detected by PCR assay. For 12months, the patient underwent for pulmonary and osseous tuberculosis. While the clinical course was favourable but deafness occurred subsequently. An association of P.aeruginosa NOE and tuberculous otomastoiditis is a highly exceptional event.

Treatment Response Evaluation in Necrotizing Otitis Externa Using 18F-FDG-PET Imaging.

This study aims to identify 18F-FDG-PET imaging features for improving treatment response evaluation in patients with necrotizing otitis externa (NOE), aiding in the difficult differentiation between sterile inflammation and active infection. Retrospective cohort study. Tertiary hospital. Patients diagnosed with NOE between 2011 and 2022. NOE criteria included otalgia, otorrhea, granulation, and radiological features consistent with osteomyelitis. 18F-FDG-PET/computed tomography (CT) parameters were derived from manually delineated regions of interest and were evaluated on both pretreatment and end-of-treatment scans. Recurrent disease of NOE after end-of-treatment 18F-FDG-PET scans. This study comprised 20 NOE patients, including 5 (25%) experiencing recurrent disease after the end-of-treatment scan. The end-of-treatment 18F-FDG-PET parameters of maximal and peak standardized uptake value (SUVmax and SUVpeak) were significantly higher in recurrent cases (p = 0.025 and p = 0.025, respectively). Both parameters demonstrated good discrimination ability in predicting recurrence, with optimal cutoffs yielding 100% sensitivity and 67% specificity. Other parameters, including mean SUV and total lesion glycolysis (TLG), did not yield significant results, neither did the calculated difference in uptake between end-of-treatment and pretreatment scans. SUVpeak on 18F-FDG-PET was the preferred parameter for treatment response evaluation of NOE at the end-of-treatment scan. A high residual SUVpeak may adequately detect patients at risk for recurrent disease, which may necessitate prolonged treatment, while low SUVpeak is found in patients with low risk for recurrent disease permitting safe treatment cessation.

Epidemiological and Mycological Profile of Otomycosis Diagnosed At the Oto-Rhino- Laryngology Department at Batna PHE – ALGERIA

Introduction: Fungal otitis or otomycosis is a relatively common pathology. Its prevalence represents according to studies 5 to 30% of all external otitis, most often chronic or subacute and benign. It can also affect the middle ear and even in some serious cases the inner ear. The main objective was to describe the epidemiological and mycological characteristics of fungal otitis and to determine their prevalence. Materials and Methods: This study is prospective descriptive, carried out in the parasitology department at the Batna University Hospital, in collaboration with the Otolaryngology department at the PHS Batna, during a period of four months. We included in our study patients with clinical symptoms pointing towards the diagnosis of infectious otitis. Each patient had an ear sample taken using a sterile, dry cotton swab. They are inoculated in suitable mycological media. The cultures are then incubated in an incubator at 27°C and 37°C for 48 hours up to one week. The identification of the different species of filamentous fungi is based on the macroscopic and microscopic aspects of the colonies. The identification of the yeast species was done by the auxacolor gallery. Results: We included 65 patients in our study, 23 of whom had proven fungal otitis (35%). We noted a predominance of the male sex (52.17%), with a sex ratio M/F = 1.09. The average age of our patients was 46.34 years, the age groups [31-45] and [46-60] were the most affected. Cleaning with cotton swabs was the most frequently found risk factor (52.27%), followed by swimming (34.43%). The most frequently found reasons for consultation were earache (48%), followed by otorrhea (31%). The location at the external auditory canal was the most frequently found (91%). We obtained 25 positive cultures; Aspergillus Niger was the most frequently isolated species (44%). Conclusion: The pathogenic role of fungi in the etiology of ear pathologies remains underestimated or even ignored. Currently, it is a well-defined pathology and a recurring problem whose involvement of fungi as pathogenic agents is increasing. This is favored by a certain number of predisposing factors. However, prophylactic measures are essential. Practitioners must advise patients on environmental and body hygiene.

Unusual Presentation of a Rare Disease: A Case Report of Fungal Necrotizing Otitis Media and Mastoiditis.

Acute necrotizing otitis media is a severe middle ear infection which causes necrosis of the tympanic cavity. A 54-year-old female was presented who suffered from diabetes mellitus and end-stage renal disease presenting with severe otalgia, initially thought to be necrotizing otitis externa. She rapidly progressed to total necrosis of the tympanic membrane. Further assessments confirmed a fungal disease caused by Candida tropicalis and Aspergillus flavus. Immediate antifungal therapy with amphotericin B and subsequent radical mastoidectomy managed to control the disease with no sign of necrosis after 3 months. Early diagnosis, aggressive systemic antifungal treatment, and surgical debridement are vital components for successful management of such cases.

Characterization, prognostic factors, and clinical profile of ear infections by Turicella otitidis: Revealing the emerging rise of a controversial pathogen.

Environmental changes and modifications in leisure habits have facilitated the emergence of new bacteria responsible for causing ear infections with different presentations. In this context, Turicella otitidis is a pathogen for which isolated cases of external and middle ear infections have been reported. However, our experience indicates a resurgence in its occurrence in recent years. The main objective of this study is to examine the possible connection between T. otitidis and the most frequent clinical ear manifestations, as well as the associated demographic characteristics. Additionally, it seeks to analyze the temporal evolution of the frequency of T. otitidis isolates and determine the overall antibiotic sensitivity pattern of this microorganism. A retrospective cohort study was conducted, including samples of ear exudates with T. otitidis from patients in the departments of Otorhinolaryngology, Pediatrics, and Emergency over the past seven years (2017-2024). Cultures were taken using fluid collection devices from the external ear in cases of diffuse external otitis (DEO) or through active, wet perforation in patients with acute otitis media (AOM) or chronic suppurative otitis media (COM). The bacterial cultures were grown using the PCR method. 67 patients (71 ears) were included, with a mean age of 19.45±22.30years, and 62.69% (n=42) being pediatric patients. The most frequent presentation was acute suppurative otitis media (AOM), accomplishing recurrent acute otitis media (rAOM) criteria in 32.35% of cases, followed by diffuse external otitis (DEO) in 41.79% (n=28) of the cases. The relationship between T. otitidis and age, and between T. otitidis and the risk of rAOM, was statistically significant (p<0.001 and p=0.01, respectively). Additionally, chronic adenoiditis/adenoid obstruction combined with age was significantly related to the risk of recurrent infections (p=0.02). Conversely, there was no significance when studying age with the risk of rAOM caused by T. otitidis alone (p=0.77). This study highlights the importance of preventing and treating ear infections caused by Turicella otitidis, especially in the context of migration and changes in leisure habits. The pathogenic role of T. otitidis is debated, suggesting its involvement in various ear infections with antibiotic resistance. Preventive measures should include maintaining good ear hygiene, regular monitoring, and appropriate antibiotic selection based on susceptibility profiles. Further research is needed to clarify its pathogenic role and its relationship with factors such as age and adenoid obstruction. Despite limitations, this study expands knowledge on these emerging infections and raises questions for future research.

EGFR Mutation in Neonatal Nephrocutaneous Syndrome: Unveiling a Genetic Challenge

AbstractEpidermal growth factor receptor (EGFR) is a transmembrane glycoprotein that exhibits tyrosine kinase signaling activity, playing a pivotal role in various cellular processes. Overexpression or overactivity of EGFR is significantly associated with inflammatory and malignant diseases, particularly lung cancer. Conversely, germline loss-of-function mutations in EGFR have been distinctly linked to a rare condition known as neonatal nephrocutaneous syndrome. We report a case of a preterm female neonate, born to consanguineous parents and from a pregnancy that was complicated by polyhydramnios. From birth, she displayed distinctive clinical features, including fragile skin and widespread erythema, sparse scalp hair, bilateral ankyloblepharon, thick eyebrows, and arachnodactyly. Subsequently, she developed progeroid features marked by skin desquamation, along with failure to thrive, diarrhea, and severe electrolyte and acid–base imbalances. Additional complications comprised anemia, generalized mucocutaneous candidiasis, external otitis, and recurrent septic episodes. Genetic analysis confirmed a homozygous EGFR mutation c.1283G &gt; A p.(Gly428Asp). The infant's neurological status remained stable, albeit requiring pain management through oral morphine and gabapentin. Palliative care became imperative, given the dismal prognosis. The identified mutation is exceedingly rare, with only 24 reported cases known thus far. Each of these instances resulted in a complex multisystemic condition marked by a wide range of challenging symptoms and signs. This clinical journey highlights the intricate interplay among genetic mutations and complex medical conditions, and underscores the critical significance of multidisciplinary care.

Comparing Treatment Choice in Acute Otitis Externa Between Primary and Secondary Care.

Comparing Treatment Choice in Acute Otitis Externa Between Primary and Secondary Care.

Prevalence of Bacterial Pathogens Isolated from Canines with Pyoderma and Otitis Externa in Korea: A Systematic Review and Meta-Analysis.

Bacterial skin infections, particularly pyoderma and otitis externa, are widespread in dogs, primarily caused by Staphylococcus and Pseudomonas species. This study evaluates the prevalence and types of bacterial pathogens in affected dogs in South Korea using a meta-analytical approach. Following the PRISMA guidelines, five electronic databases were searched for relevant studies published between 1990 and 2024. Three researchers independently performed data extraction and quality assessment. A subgroup analysis explored the variability in pathogen prevalence across studies based on bacterial genus, bacterial species, publication year, sampling year, sampling location, infection type, diagnostic method, and sample size. Publication bias was evaluated using funnel plots and Egger's regression test, with all analyses conducted using the R program. Of the 944 articles, 29 met the eligibility criteria. The pooled bacterial prevalence among infected dogs was 99.95% (95%CI: 99.85-100). Staphylococcus was the most prevalent genus (95.93%), followed by Pseudomonas (48.43%), Enterococcus (20.32%), and Escherichia (17.63%). The most common species were Staphylococcus pseudintermedius (78.89%), Staphylococcus intermedius (71.43%), and Pseudomonas aeruginosa (46.13%). This study underscores the need for comprehensive treatment strategies targeting Gram-negative and Gram-positive bacteria, emphasizing further research on antimicrobial resistance patterns and treatment efficacy to enhance canine health outcomes in South Korea.

A Comparative Study of the Effectiveness of Antibiotic-Steroid Ointment Wick V/S Antibiotic-Steroid Drops Soaked Gel Foam in Pain Management of Otitis Externa

A Comparative Study of the Effectiveness of Antibiotic-Steroid Ointment Wick V/S Antibiotic-Steroid Drops Soaked Gel Foam in Pain Management of Otitis Externa

Increased Rates of Infectious Diseases in Fibromyalgia Patients: A Population-Based Case-Control Study.

Introduction: Fibromyalgia (FM) patients are known to have medical comorbidities. This study characterized the rates of infectious diseases in FM patients compared to the general population. Methods: A nationwide population-based case-control study was conducted, including all patients diagnosed with FM by a rheumatologist compared to a matched 5:1 control group within a large health maintenance organization in Israel (January 2002 to December 2023). Demographic, anthropometric, and health habit data were extracted from medical records as well as the ICD-9 codes of diagnoses related to infectious diseases in 9232 FM patients and 46,160 controls. Infection rates in the FM patients were compared to the controls over a mean follow-up of 6.7 years. Results: The FM patients had a significantly higher incidence of viral, bacterial, fungal, and parasitic diseases compared to the controls. The FM patients had significantly higher odds ratios (ORs) for respiratory/sinopulmonary infections, including upper respiratory tract infections (OR = 1.49), influenza (OR = 1.80), tonsillitis (OR = 1.40), sinusitis (OR = 1.98), otitis media (OR = 1.84), otitis externa (OR = 1.48), and pneumonia (OR = 1.60), all p < 0.01. They also experienced more gastrointestinal infections, including gastroenteritis (OR = 1.40), Helicobacter pylori (OR = 2.05), candidal esophagitis (OR = 7.88), and giardiasis (OR = 3.41), all p < 0.01. They had a higher prevalence of genitourinary infections, including urinary tract infections (OR = 1.79) and pelvic inflammatory disease (OR = 3.17), p < 0.01 as well as skin infections such as abscess (OR = 1.74) and cellulitis (OR = 1.64) and systemic infections such as symptomatic COVID-19 (OR = 1.76) and Cytomegalovirus (CMV) (OR = 1.85), all p < 0.01. Conclusions: The FM patients had a significantly higher incidence of infectious diseases than the general population. Further research is needed to better understand the underlying mechanisms and develop targeted interventions to address infection risks in FM patients.

A Rare Case of Limited Granulomatosis with Polyangiitis Presenting as Bilateral Parotitis.

Granulomatosis with polyangiitis (GPA) is a rare autoimmune vasculitis affecting small and medium-sized vessels, commonly involving the respiratory tract and kidneys. Salivary gland involvement, particularly bilateral parotitis, is an uncommon presentation of GPA. We report the case of a 38-year-old Asian male who presented with left ear pain and parotid swelling after a water park visit. Initially treated with antibiotics for suspected otitis externa, his symptoms worsened, leading to bilateral parotitis, facial palsy, and otomastoiditis. Imaging revealed parotid abscesses and lab results showed elevated antineutrophil cytoplasmic antibodies (ANCA), specifically cytoplasmic ANCA directed against proteinase 3, confirming the diagnosis of GPA. Cultures and autoimmune workups for other causes, such as Sjogren's syndrome and immunoglobulin G4-related disease, were negative. Treatment with high-dose corticosteroids and methotrexate resulted in significant clinical improvement. This case highlights the importance of considering GPA in atypical presentations such as parotitis, even in the absence of renal involvement. Early diagnosis and appropriate immunosuppressive therapy are critical to prevent further complications in multisystem involvement. This case highlights the importance of recognizing atypical manifestations of granulomatosis with polyangiitis (GPA), such as bilateral parotitis, which aids in diagnosing and treating rare presentations more effectively.It emphasizes the need to expand differential diagnoses of salivary gland involvement, guiding the distinction of GPA from other similar conditions when antibiotics fail.By highlighting a rare presentation of GPA, this case improves diagnostic understanding in autoimmune diseases, enabling earlier interventions and leading to better patient outcomes.

Neurologic symptoms due to cholesteatoma in a cat with lysis of the temporal and occipital bone demonstrated by computed tomography and magnetic resonance imaging

AbstractA 7‐year‐old cat was presented with vestibular signs. The cat had a history of a presumed aural polyp that had been removed via ventral bulla osteotomy 4 years prior to presentation, followed by bacterial otitis externa and media that had been treated medically and healed within 8 weeks. At representation, computed‐tomographic imaging and video‐otoscopy showed obstruction of the right tympanic bulla by a heterogeneous mass, severe lysis of the surrounding bones, and pale, friable material within the horizonal external ear canal, extruding from the middle ear. The bacterial culture was negative. Histopathologic examinations supported the diagnosis of cholesteatoma. Due to the rapid progression of the disease, the cat was humanely euthanased 2 months later. Before euthanasia, magnetic resonance imaging documented the worsening of the disease, with an increased size of the expansile lesion and progressive changes in the adjacent structures. Furthermore, additional signs of otitis interna were visible.

C-reactive protein (CRP) and otorrhoea as prognosticate markers for necrotising otitis externa treatment response: based on a retrospective cohort study of 62 patients

Background Recurrence rate of necrotising otitis externa (NOE) after treatment is 15-20%. This is mainly due to a lack of reliable clinical indicator for the resolution of disease. Aims We aim to assess the predictability of the otalgia, otorrhoea and C-reactive protein (CRP) levels in a large cohort of sixty-two patients for treatment outcome. Methods Consecutive patients treated for NOE in our Nottingham tertiary ENT referral unit were retrospectively reviewed from January 2017 to June 2020. Diagnoses were made based on clinical findings and imaging. Good response to treatment was defined as those who required treatment of not longer than the standard six weeks of systemic antibiotics. Results Average age at presentation was 78.4 years. 75.8% of patients were male. 62.9% had diabetes. Ten patients received more than the standard six weeks of systemic antibiotics. Complications from disease progression included cranial nerve neuropathies (14.5%), meningitis (3.2%), and sigmoid sinus thrombosis (3.2%). Two patients had recurrent or persistent NOE and died while on treatment. Delays in normalization of CRP (p = 0.015) and resolution of otorrhoea (p = 0.014) were associated with an increased need for prolonged antibiotic treatment. Conclusion Normalisation of CRP and resolution of otorrhea can assist in identifying patients who will likely benefit from a prolonged course of systemic antibiotics.

Treatment of Otitis Externa in Cats (&lt;em&gt;Malassezia&lt;/em&gt; sp): Epidemic Genius

External otitis is one of the primary complaints affecting small animals. Traditional treatments, such as antibiotics and topical medications, have varying degrees of success and often result in side effects or incomplete resolution of symptoms. Therefore, the search for more effective and safer treatments is crucial. Homeopathic medicine offers an alternative approach, using substances that stimulate the body's innate healing abilities by considering the individual’s specific symptoms, temperament, and overall health to promote lasting healing. This study aims to evaluate the efficacy of homeopathic treatment for external otitis in cats by examining clinical outcomes and providing insights for future treatment protocols. Eight female cats with pruritus were examined. Upon examination and plate analysis, many Malassezia sp. were observed. Based on the clinical signs demonstrated by the animals, symptoms were selected for repertorization and medication choice (Epidemic Genius). The eight cats received Apis mellifica 12 cH, Malassezia sp. 30 cH in their drinking water for 15 days, and Calendula Glyceroleum for external use for daily cleaning. After one week of treatment, new samples were collected for analysis of the ear canal and testing for Malassezia sp. It was found that 100% of the animals no longer presented Malassezia sp. in the examination or had an extremely low number (considered normal). Homeopathy, through treatment with Epidemic Genius, proved to be effective in treating the eight cats.

Future Challenge: Assessing the Antibiotic Susceptibility Patterns of Staphylococcus Species Isolated from Canine Otitis Externa Cases in Western Romania.

Antimicrobial resistance (AMR) has surfaced as a critical challenge to public health on a global scale. The precise and swift identification of resistance to antimicrobial agents, along with timely and suitable antimicrobial therapy paired with effective stewardship practices, is crucial for managing the rise and dissemination of antimicrobial resistance. The objective of our investigation was to outline the antimicrobial resistance profile of Staphylococcus spp., a significant contributor to canine otitis, a prevalent condition in dogs, isolated in Western Romania. All data were collected from clinical cases of canine otitis externa which presented at the University Clinic of the Faculty of Veterinary Medicine in Timișoara/Romania. A clinical evaluation was conducted, from which era swabs are usually collected and sent for analysis at the laboratory. Laboratory analysis included the microbiological examination for identifying Staphylococcus spp. and determining antibiotic susceptibility phenotypes. Statistical analysis was implemented on all data that were collected. The ear swabs were processed with standard procedures for cultivating and identifying bacteria. The resulting subcultures were processed to determine the staphylococcal species on the GP ID Cards of the Vitek® 2 automatic system. The antimicrobial susceptibility profiles were detected by the Vitek® 2 system using an AST-GP80 card. These isolated Staphylococcus spp. strains were further processed by real-time PCR and PCR-RFLP. Of all the auricular exudate samples analyzed, 76 were positive for Staphylococcus spp. (59.38%). Within these, in 82% of auricular samples, six distinct Staphylococcus spp. were identified (Staphylococcus (S.) pseudintermedius, S. intermedius, S. hyicus, S. delphiny, S. shleiferi, and S. aureus). Our data indicate that the PCR-RFLP assay is a practical approach to S. pseudintermedius identification, allowing for discrimination from the other Staphylococcus Intermedius Group (SIG) species and important staphylococcal pathogens of dogs. The highest frequency of resistant S. pseudintermedius isolates was detected against tetracycline (21/34; 61.76%; p-value 0.003), gentamicin (20/34; 58.82%), and kanamycin (20/34; 58.82%). These results are essential to guide the prudent use of antibiotics in veterinary medicine. They will also help design efficient control strategies and measure their effectiveness.

Malignant otitis externa: What is the role of surgery?

AbstractObjectiveMalignant otitis externa (MOE) is typically managed with long‐term broad‐spectrum antibiotics. The impact of surgical intervention on clinical outcomes is not well described. This study aims to compare clinical outcomes of MOE patients managed with or without surgery.Study Design/SettingRetrospective cohort, academic tertiary referral center.MethodsPatients diagnosed with MOE between January 2010 to September 2022 were included. Univariate analyses compared symptoms at initial presentation and long‐term (≥1 year) outcomes between surgical and non‐surgical patients.ResultsA total of 23 patients were included (78% male, mean age 69 ± 13 years, median follow‐up 305 days). Most (N = 22, 96%) patients were diabetic. Seventeen (74%) underwent surgical intervention (76% tympanomastoidectomy, 24% external auditory canal debridement and biopsy). Poor facial nerve (FN) function at initial presentation (defined as House‐Brackmann [HB] grade ≥3) significantly predicted undergoing surgical intervention (p = 0.02). Comparing surgically managed versus non‐surgical patients at the time of presentation, there were no differences in the degree of hearing loss, severity of diabetes, rate of insulin dependence, incidence of immunosuppression, or the Charlson Comorbidity Index (all p &gt; 0.05). FN outcomes at long‐term follow‐up also did not significantly differ (p &gt; 0.05). No significant differences in the length of stay (9 vs. 6 days, p = 0.2), rate of readmission (31% vs. 17%, p = 0.5) or 5‐year overall survival (53% vs. 66%, p = 0.6) were observed between surgical and non‐surgical patients.ConclusionsLong‐term outcomes for patients with MOE remain poor. Patients with poor FN function at presentation were more likely to undergo surgical intervention. Patient comorbidities, including the severity of diabetes, were not predictive of undergoing surgery. However, surgical intervention for MOE did not appear to lower the length of stay, the rate of hospital readmission, or overall mortality in our cohort.Level of EvidenceIII

Approach to otitis externa in Australian general practice.

Acute otitis externa (AOE) is an inflammatory condition of the outer ear seen in Australian general practice and isprevalent in tropical climates like NorthQueensland. This article aims to delineate key facets ofAOE, identify high-risk populations andpropose a streamlined management approach aligned with the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) guideline, emphasising the role of primary care inoptimal patient care. Outlined within this article are key elements of AOE, from anatomy to riskfactors, examination, diagnosis, differentials, management, prevention andindications for referral. Emphasis isplaced on topical antibiotic use, drugdelivery techniques and recognising refractory cases. The importance of early intervention is highlighted to prevent complications, particularly in at-risk populations, aligned with AAO-HNS guidelines and enhancing general practice's role in mitigating AOE-related complications.