Otitis Externa in Secondary Care: A Change in Our Practice Following a Full Cycle Audit
نویسندگان
چکیده
Otitis externa is a common condition affecting 1–3% of the population.1 The patients often present initially to primary care. They should be referred to an ear, nose and throat (ENT) specialist if the symptoms persist despite the initial treatment with antimicrobial drops. Multifactorial issues exist as to why this occurs. However, the most common reason to seek specialist input is to address the stenosed external acoustic meatus secondary to the edema and debris in the ear canal requiring microsuction, or if there is any suspicion of malignant otitis externa. TheNational Institute forHealth andCare Excellence (NICE) has issued a guideline for the investigation and treatment of otitis externa.2 According to the guideline,2 routine ear swabs should not be taken from patients presenting with otitis externa. This is because most of the empirical antimicrobial eardrops are sensitive to the usual pathogens.3While there is a plethora of antimicrobial eardrops available, concerns arose that different preparations of eardrops were prescribed without considering the cost. Furthermore, the interpretation of culture results is made difficult by the fact that the reported bacterial susceptibility is determined for systemic antibiotics and not for topical administration.2,3 Concurrently, it is also difficult to differentiate the disease-causing organisms from the contaminants.3 However, ear swabs do have value in determining antibiotic resistant cultures in refractory cases (when the symptoms have lasted for more than 3 months).3
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