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Patients’ experience of necrotising otitis externa: a qualitative study

Published online by Cambridge University Press:  28 March 2022

E Owen ,
R Abrar  and
E Stapleton Open the ORCID record for E Stapleton [Opens in a new window]
E Owen
Affiliation:
Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
R Abrar
Affiliation:
Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
E Stapleton*
Affiliation:
Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
*
Author for correspondence: Dr Emma Stapleton, Department of Otolaryngology, Peter Mount Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK E-mail: emmastapleton@doctors.org.uk
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Abstract

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.

Keywords

Otitis ExternaPainPatientsQuality Of LifeDiabetes MellitusOsteomyelitisQualitative Research
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 4 , April 2023 , pp. 356 - 362
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr E Stapleton takes responsibility for the integrity of the content of the paper

This paper was presented orally at the British Society of Otology free papers meeting 30th June 2021, where it won the prize for best presentation by a medical student.

References

Stern Shavit, S, Soudry, E, Hamzany, Y, Nageris, B. Malignant external otitis: factors predicting patient outcomes. Am J Otolaryngol 2016;37:425–30CrossRefGoogle ScholarPubMed
Rubin Grandis, J, Branstetter, BF, Yu, VL. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis 2004;4:34–9CrossRefGoogle ScholarPubMed
Khan, MA, Quadri, SAQ, Kazmi, AS, Kwatra, V, Ramachandran, A, Gustin, A et al. A comprehensive review of skull base osteomyelitis: diagnostic and therapeutic challenges among various presentations. Asian J Neurosurg 2018;13:959–70Google ScholarPubMed
Bovo, R, Benatti, A, Ciorba, A, Libanore, M, Borrelli, M, Martini, A. Pseudomonas and Aspergillus interaction in malignant external otitis: risk of treatment failure. Acta Otorhinolaryngol Ital 2012;32:416–19Google ScholarPubMed
Lambor, DV, Das, CP, Goel, HC, Tiwari, M, Lambor, SD, Fegade, MV. Necrotising otitis externa: clinical profile and management protocol. J Laryngol Otol 2013;127:1071–7CrossRefGoogle ScholarPubMed
Al Aaraj, MS, Kelley, C. Malignant Otitis Externa. Treasure Island, FL: StatPearls Publishing, 2020Google Scholar
Hatch, JL, Bauschard, MJ, Nguyen, SA, Lambert, PR, Meyer, TA, McRackan, TR. Malignant otitis externa outcomes: a study of the university HealthSystem Consortium database. Ann Otol Rhinol Laryngol 2018;127:514–20CrossRefGoogle ScholarPubMed
Marina, S, Goutham, MK, Rajeshwary, A, Vadisha, B, Devika, T. A retrospective review of 14 cases of malignant otitis externa. J Otol 2019;14:63–6CrossRefGoogle ScholarPubMed
Cohen, D, Friedman, P. The diagnostic criteria of malignant external otitis. J Laryngol Otol 1987;101:216–21CrossRefGoogle ScholarPubMed
Adams, A, Offiah, C. Central skull base osteomyelitis as a complication of necrotizing otitis externa: imaging findings, complications, and challenges of diagnosis. Clin Radiol 2012;67:e7–16CrossRefGoogle ScholarPubMed
Manso, MC, Rodeia, SC, Rodrigues, S, Cavilhas, P, Domingos, R. Malignant otitis externa and stroke. Eur J Case Rep Intern Med 2016;3:000387Google ScholarPubMed
Bernstein, JM, Holland, NJ, Porter, GC, Maw, AR. Resistance of Pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa. J Laryngol Otol 2007;121:118–23CrossRefGoogle ScholarPubMed
Loh, S, Loh, WS. Malignant otitis externa: an Asian perspective on treatment outcomes and prognostic factors. Otolaryngol Neck Surg 2013;148:991–6CrossRefGoogle ScholarPubMed
Arsovic, N, Radivojevic, N, Jesic, S, Babac, S, Cvorovic, L, Dudvarski, Z. Malignant otitis externa: causes for various treatment responses. J Int Adv Otol 2020;16:98–103CrossRefGoogle ScholarPubMed
Chawdhary, G, Pankhania, M, Douglas, S, Bottrill, I. Current management of necrotising otitis externa in the UK: survey of 221 UK otolaryngologists. Acta Otolaryngol (Stockh) 2017;137:818–22CrossRefGoogle ScholarPubMed
Glikson, E, Sagiv, D, Wolf, M, Shapira, Y. Necrotizing otitis externa: diagnosis, treatment, and outcome in a case series. Diagn Microbiol Infect Dis 2017;87:74–8CrossRefGoogle ScholarPubMed
Wiegand, S, Berner, R, Schneider, A, Lundershausen, E, Dietz, A. Otitis externa. Dtsch Arztebl Int 2019;116:224–34Google ScholarPubMed
Stapleton, E, Watson, G. Emerging themes in necrotising otitis externa: a scoping review of the literature from 2011 to 2020 and recommendations for future research. J Laryngol Otol 2022;136:575–81CrossRefGoogle ScholarPubMed
Chawdhary, G, Liow, N, Democratis, J, Whiteside, O. Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistics trends. J Laryngol Otol 2015;129:600–3CrossRefGoogle Scholar
Department of Health. NHS patient experience framework. In: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/215159/dh_132788.pdf [27 September 2022]Google Scholar
Sbaraini, A, Carter, SM, Evans, RW, Blinkhorn, A. How to do a grounded theory study: a worked example of a study of dental practices. BMC Med Res Methodol 2011;11:128CrossRefGoogle Scholar
Felce, D, Perry, J. Quality of life: its definition and measurement. Res Dev Disabil 1995;16:51–74CrossRefGoogle ScholarPubMed
Rolfe, DE, Ramsden, VR, Banner, D, Graham, ID. Using qualitative Health Research methods to improve patient and public involvement and engagement in research. Res Involv Engagem 2018;4:49CrossRefGoogle ScholarPubMed
Long, DA, Koyfman, A, Long, B. An emergency medicine-focused review of malignant otitis externa. Am J Emerg Med 2020;38:1671–8CrossRefGoogle ScholarPubMed
Yang, T-H, Xirasagar, S, Cheng, Y-F, Wu, C-S, Kao, Y-W, Shia, B-C et al. Malignant otitis externa is associated with diabetes: a population-based case-control study. Ann Otol Rhinol Laryngol 2020;129:585–90CrossRefGoogle ScholarPubMed
Vgontzas, AN, Liao, D, Pejovic, S, Calhoun, S, Karataraki, M, Basta, M et al. Insomnia with short sleep duration and mortality: the Penn State Cohort. Sleep 2010;33:1159–64CrossRefGoogle ScholarPubMed
Hobson, CE, Moy, JD, Byers, KE, Raz, Y, Hirsch, BE, McCall, AA. Malignant otitis externa: evolving pathogens and implications for diagnosis and treatment. Otolaryngol Neck Surg 2014;151:112–16CrossRefGoogle ScholarPubMed
Soudry, E, Hamzany, Y, Preis, M, Joshua, B, Hadar, T, Nageris, BI. Malignant external otitis: analysis of severe cases. Otolaryngol Neck Surg 2011;144:758–62CrossRefGoogle ScholarPubMed
Phyo, AZZ, Freak-Poli, R, Craig, H, Gasevic, D, Stocks, NP, Gonzalez-Chica, DA et al. Quality of life and mortality in the general population: a systematic review and meta-analysis. BMC Public Health 2020;20:1596CrossRefGoogle ScholarPubMed
Pulcini, C, Mahdyoun, P, Cua, E, Gahide, I, Castillo, L, Guevara, N. Antibiotic therapy in necrotising external otitis: case series of 32 patients and review of the literature. Eur J Clin Microbiol Infect Dis 2012;31:3287–94CrossRefGoogle ScholarPubMed
Stern Shavit, S, Bernstine, H, Sopov, V, Nageris, B, Hilly, O. FDG-PET/CT for diagnosis and follow-up of necrotizing (malignant) external otitis. Laryngoscope 2019;129:961–6CrossRefGoogle ScholarPubMed