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3 results

  • Characteristics, management and outcome of a large necrotising otitis externa case series: need for standardised case definition

  • S H Hodgson, V J Sinclair, J Arwyn-Jones, K Oh, K Nucken, M Perenyei, V Sivapathasingam, P Martinez-Devesa, S T Pendlebury, J D Ramsden, P C Matthews, P Pretorius, M I Andersson
  • Journal:
    The Journal of Laryngology & Otology / Volume 136 / Issue 7 / July 2022
    Published online by Cambridge University Press:
    19 January 2022, pp. 604-610
    Print publication:
    July 2022
    • Article
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  • Background

    Necrotising otitis externa is a severe ear infection for which there are no established diagnostic or treatment guidelines.

    Method

    This study described clinical characteristics, management and outcomes for patients managed as necrotising otitis externa cases at a UK tertiary referral centre.

    Results

    A total of 58 (63 per cent) patients were classified as definite necrotising otitis externa cases, 31 (34 per cent) as probable cases and 3 (3 per cent) as possible cases. Median duration of intravenous and oral antimicrobial therapy was 6.0 weeks (0.49–44.9 weeks). Six per cent of patients relapsed a median of 16.4 weeks (interquartile range, 23–121) after stopping antimicrobials. Twenty-eight per cent of cases had complex disease. These patients were older (p = 0.042), had a longer duration of symptoms prior to imaging (p < 0.0001) and higher C-reactive protein at diagnosis (p = 0.005). Despite longer courses of intravenous antimicrobials (23 vs 14 days; p = 0.032), complex cases were more likely to relapse (p = 0.016).

    Conclusion

    A standardised case-definition of necrotising otitis externa is needed to optimise diagnosis, management and research.

  • 3.5.2 - Acute Pancreatitis

  • from Section 3.5 - Acute Gastrointestinal Failure
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 208-210

  • Summary

    Key Learning Points

    1. 1. Diagnosis requires two of the following criteria: abdominal pain consistent with acute pancreatitis, serum amylase/lipase over three times the reference range or findings suggestive of acute pancreatitis on cross-sectional imaging.

    2. 2. Severe acute pancreatitis is characterised by organ failure persisting for over 48 hours, and carries a mortality risk of 15–20 per cent.

    3. 3. Management is predominantly supportive. Operative intervention has a role only in the later stages of the disease.

    4. 4. Prophylactic antibiotics are not recommended; however, they may be indicated in the event of a secondary infection.

    5. 5. Enteral nutrition can be given via nasogastric or nasojejunal routes, and is preferred to parenteral nutrition.