Diagnostic criteria and core outcome set development for necrotising otitis externa: the COSNOE Delphi consensus study.

OBJECTIVE: Evidence for necrotising otitis externa (NOE) diagnosis and management is limited, and outcome reporting is heterogeneous. International best practice guidelines were used to develop consensus diagnostic criteria and a core outcome set (COS). METHODS: The study was pre-registered on the Core Outcome Measures in Effectiveness Trials (COMET) database. Systematic literature review identified candidate items. Patient-centred items were identified via a qualitative study. Items and their definitions were refined by multidisciplinary stakeholders in a two-round Delphi exercise and subsequent consensus meeting. RESULTS: The final COS incorporates 36 items within 12 themes: Signs and symptoms; Pain; Advanced Disease Indicators; Complications; Survival; Antibiotic regimes and side effects; Patient comorbidities; Non-antibiotic treatments; Patient compliance; Duration and cessation of treatment; Relapse and readmission; Multidisciplinary team management.Consensus diagnostic criteria include 12 items within 6 themes: Signs and symptoms (oedema, otorrhoea, granulation); Pain (otalgia, nocturnal otalgia); Investigations (microbiology [does not have to be positive], histology [malignancy excluded], positive CT and MRI); Persistent symptoms despite local and/or systemic treatment for at least two weeks; At least one risk factor for impaired immune response; Indicators of advanced disease (not obligatory but mut be reported when present at diagnosis). Stakeholders were unanimous that there is no role for secondary, graded, or optional diagnostic items. The consensus meeting identified themes for future research. CONCLUSION: The adoption of consensus-defined diagnostic criteria and COS facilitates standardised research reporting and robust data synthesis. Inclusion of patient and professional perspectives ensures best practice stakeholder engagement.

Otitis media with effusion.

Otitis media with effusion (OME) is a common problem facing general practitioners, pediatricians and otolaryngologists. This article reviews the etiopathogenesis, epidemiology, presentation, natural history and management of OME. The literature was reviewed by using the PubMed search engine and entering a combination of terms including 'otitis media with effusion', 'epidemiology' and 'management'. Relevant articles were identified and examined for content. What is the take home message? While OME is a very common entity in the pediatric population, the majority of cases will resolve spontaneously. Surgery in the form of grommet insertion, with or without adenoidectomy is the most effective treatment in persistent symptomatic cases.

Acute otitis media.

Acute otitis media (AOM) is a common problem facing general practitioners, paediatricians and otolaryngologists. This article reviews the aetiopathogenesis, epidemiology, presentation, natural history, complications and management of AOM. The literature was reviewed by using the PubMed search engine and entering a combination of terms including 'AOM', 'epidemiology' and 'management'. Relevant articles were identified and examined for content. What is the take-home message? AOM is a very common problem affecting the majority of children at least once and places a large burden on health care systems throughout the world. Although symptomatic relief is often enough for most children, more severe and protracted cases require treatment with antibiotics, especially in younger children.

Chronic otitis media.

Chronic otitis media (COM) is a common problem facing general practitioners, pediatricians and otolaryngologists. This article reviews the aetiopathogenesis, epidemiology, presentation, natural history, complications and management of COM. The literature was reviewed by using the PubMed search engine and entering a combination of terms including "COM", "diagnosis", "incidence", "complications" and "management". Relevant articles were identified and examined for content. What is the "take-home" message for the clinician? COM is a common problem with various sub-categories according to the disease state. It most commonly presents with painless otorrhoea and hearing loss. Treatment options vary according to the activity and type of disease encountered. COM carries significant patient morbidity.

Consenting Practice of ENT Trainees: To What Extent Is Trainee Involvement Disclosed?

AIM: To assess to what extent ENT trainees disclose their involvement in operations to their patients when obtaining consent. BACKGROUND: It is not clear how the trainees are conducting the consenting process, although it could lead to a medico-legal conflict. DESIGN AND PARTICIPANTS: A 6-question questionnaire was sent via email to 22 ENT trainees in Northern Deanery, and 14 ENT registrars in Yorkshire Deanery. MAIN OUTCOME MEASURES: Seniority of the participants. Disclosure of the main operating surgeon and trainee involvement in the consenting process. Influence of operation complexity in trainee involvement disclosure. RESULTS: The response rate was 69%. Of the respondents, 46% consistently informed patients about trainee involvement in operations. Only 28% felt the complexity of operations influenced their decision to disclose trainee involvement. Subgroup analysis showed there was no statistically significant difference between junior and senior trainees in trainee involvement disclosure. If the trainees informed patients about who the operator would be, it was more likely for them to also disclose their own involvement. Many trainees also felt that the 'no guarantee of a particular surgeon' clause in the National Health Service consent form implied possible trainee involvement even if they did not specify it verbally. CONCLUSION: The rate of trainee involvement disclosure is not related to the seniority of trainee or complexity of operations, but is related to operator disclosure. This may suggest trainee involvement disclosure is not dependent on the level of confidence of trainees but on the approach and attitude towards the consenting process.

Clinical relevance of immune parameters in the tumor microenvironment of head and neck cancers.

BACKGROUND: The tumour microenvironment is a highly complex region where multiple interactions occur between host and cancer cells. The host response is defined by the presence and function of different tumour infiltrating lymphocytes and cytokines. Head and neck squamous cell carcinomas comprise a subgroup of human cancers with significant morbidity and mortality. METHOD: A literature review was performed to identify studies, which have investigated the impact of immune factors within the tumour microenvironment of head and neck squamous cell carcinomas on clinical outcomes. RESULTS: Higher counts of intratumoral dendritic cells and CD8+ T-lymphocytes are associated with a favorable prognosis in head and neck cancers. However, contrasting results have been found with T-regulatory cells whereby higher intratumoral counts appear favorable particularly in tumours of oropharyngeal origin. A number of studies have found a link between various biomarkers, e.g. IL-10 in oral cancers, and clinical outcome. CONCLUSIONS: We have identified immune factors within the tumour microenvironment, which are critically related to prognosis and also those, which require further work to elucidate their full relevance. Furthermore it is clear that if immunotherapy is to be introduced as an adjunct in the treatment of head and neck cancers, different immunological parameters will need to be selected for each distinct subsite.