Necrotising otitis externa is an aggressive infection of the external ear, the incidence of which is increasing.Reference Eweiss, Al-Aaraj, Sethukumar and Jama1–Reference Rojoa, Raheman, Saman, Mettias, Das and Rea4 The optimal strategy for the diagnosis and management of necrotising otitis externa remains uncertain, and there is considerable variability in how the condition is managed.Reference Chawdhary, Pankhania, Douglas and Bottrill5,Reference Hopkins, Bennett, Henderson, MacSween, Baring and Sutherland6 Several articles in this month's issue of The Journal of Laryngology & Otology address this condition.Reference Stapleton and Watson7–Reference Mohammed, Chean Khun Ng, Qureshi and Yates9
In a scoping review of necrotising otitis externa by Stapleton and Watson, the literature from 2011 to 2020 is reviewed and recommendations made for future research.Reference Stapleton and Watson7 A total of 217 studies were identified, with 60 being filtered into the final scoping review. Forty-three out of 60 studies (72 per cent) were retrospective case series, with no current level 1, 2 or 3 evidence for the diagnosis and management of necrotising otitis externa. The authors conclude that without an agreed framework of definitions and a standardised reporting dataset, published work remains heterogeneous, with a paucity of scientific analysis. This conclusion is supported by a further article by Hodgson et al. in this month's issue, who also conclude that a standardised case definition of necrotising otitis externa is needed to optimise diagnosis, management and research.Reference Hodgson, Sinclair, Arwyn-Jones, Oh, Nucken and Perenyei8 The UK Necrotising Otitis Externa Collaborative aims to establish consensus definitions to facilitate the diagnosis, management and outcomes of necrotising otitis externa in order to support clinical practice. In addition, a UK, multicentre, prospective observational study focused on improving necrotising otitis externa outcomes is currently underway (the Improving Outcomes of Necrotising Otitis Externa (‘IONOE’) study).
Telephone consultations and triage have rapidly increased in the out-patient setting because of the coronavirus pandemic.Reference Zammit, Siau, Williams and Hussein10–Reference Hogan, Hintze, Fitzgerald, Javadpour, Rawluk and McConn13 Two further studies in this month's issue report the positive effects of telephone clinics as a method of service delivery.Reference Mallick, Balakumar and Drysdale14,Reference Rovira, Brar, Munroe-Gray, Ofo, Rodriguez and Kim15
Chronic eczematous external otitis can be challenging to manage. Nemeth et al., in a randomised, controlled trial in this month's issue, compare the effects of pimecrolimus against a moderate-potency topical steroid.Reference Nemeth, Verga and Verdolini16 The authors conclude that pimecrolimus is an effective treatment for eczematous external otitis and has a more favourable safety profile than topical steroids. A larger, high-powered study is required to explore further the full potential of pimecrolimus in eczematous external otitis cases.
