Incidence and Management of Acute Otitis Externa in a UK Centre Before and During the COVID-19 Pandemic

Year 2022, Volume: 32 Issue: 3, 47 - 50, 28.09.2022

Rachel Ho Fergus Cooper , Ying Tian Lim Isha Iqbal Muhammad Shakeel

https://doi.org/10.26650/Tr-ENT.2022.1095406

Abstract

Objective: Patients with otitis externa (OE) are commonly referred to acute ENT services after failed treatment in community. This case series analyses the prevalence and management of OE in a UK ENT rapid access clinic (RAC) prior to and following the national lockdown imposed in March 2020. Materials and Methods: Retrospective case review of all patients referred with OE to the RAC between January 2019 and March 2021 with comparison of the cohorts before and after 1st March 2020. Data anaylsed included demographics, treatment methods, rates of admission, microbiological swab and CT results and rates of necrotising otitis externa (NOE). Results: There were 239 new referrals over the total study period. The rate of referral dropped from 12.1/month to 5.8/month following the March 2020 lockdown. There were no significant differences in rates of severe infection or NOE before and after the lockdown. The most common organisms grown were Pseudomonas aeruginosa, Candida, and Staphylococcus aureus. Conclusions: There was a considerable reduction in acute referrals for OE to this centre in the year following the March 2020 lockdown. There was no significant change in disease severity or management trends.

Keywords

Otitis Externa, Referral and Consultation, COVID-19

References

• 1. NICE Clinical Knowledge Summaries - Otitis Externa. https://cks. nice.org.uk/topics/otitis-externa/. Published 2021. Accessed July 20, 2021. google scholar
• 2. Smith ME, Hardman JC, Mehta N, Jones GH, Mandavia R, Anderson C, et al. Acute otitis externa: Consensus definition, diagnostic criteria and core outcome set development. PloS one 2021; 16(5):e0251395. doi: 10.1371/journal.pone.0251395. google scholar
• 3. Martinez Devesa P, Willis CM, Capper JW. External auditory canal pH in chronic otitis externa. Clin Otolaryngol Allied Sci 2003;28(4):320-4. google scholar
• 4. Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg 2014;150 (1 Suppl):S1-24. google scholar
• 5. Gonzalez JL, Suarez LL, de Leon JE. Malignant otitis externa: an updated review. Am J Otolaryngol 2021;42(2):102894. google scholar
• 6. Kaushik V, Malik T, Saeed SR. Interventions for acute otitis externa. Cochrane Database Syst Rev 2010; (1):CD004740. google scholar
• 7. Murphy M, Scott LJ, Salisbury C, Turner A, Scott A, Denholm R, Lewis R, Iyer G, Macleod J, Horwood J. Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study. Br J Gen Pract 2021;71(704):e166-77. doi: 10.3399/BJGP.2020.0948. google scholar
• 8. Osborne MS, Bentley E, Farrow A, Chan J, Murphy J. Impact of coronavirus disease 2019 on urgent referrals to secondary care otolaryngology: a prospective case series. J Laryngol Otol 2020;134(11):957-60. doi:10.1017/S0022215120002091 google scholar
• 9. Mansfield KE, Mathur R, Tazare J, Henderson AD, Mulick AR, Carreira H, et al. Indirect acute effects of the COVID-19 pandemic on physical and mental health in the UK: a population-based study. Lancet Digit Health 2021;3(4):e217-30. doi: 10.1016/S2589-7500(21)00017-0. google scholar
• 10. Nab M, van Vehmendahl R, Somers I, Schoon Y, Hesselink G. Delayed emergency healthcare seeking behaviour by Dutch emergency department visitors during the first COVID-19 wave: a mixed methods retrospective observational study. BMC emergency medicine. 2021;21(1):56. doi: 10.1186/s12873-021-00449-9. google scholar
• 11. Affendi A, O’sullivan R, Kavanaugh F, Dias A, O’sullivan P, Sheahan P, Khan MH. Safety of emergency ent procedures during COVID-19 pandemic. Irish Medical Journal 2020;113(10):1-7. google scholar
• 12. Hajioff D, MacKeith S. Otitis externa. BMJ Clin Evid 2015;2015:0510. google scholar
• 13. Goodman WS, Middleton WC. The management of chronic external otitis. J Otolaryngol 1984;13(3):183-6. google scholar