Objectives: To compare outcomes of telephone and face-to-face consultations for new otology referrals and discuss the wider use of telemedicine in otology. Design: Retrospective cohort study. Setting: UK secondary/tertiary referral unit. Participants: New adult otology referrals to our unit, sampled consecutively between March 2021 and May 2021, reviewed in either a face-to-face or telephone clinic. Main outcome measures: Primary outcome measure was the proportion of patients with a definitive management outcome (discharged or added to waiting list for treatment) versus the proportion of patients requiring follow-up for further assessment or review. Results: 150 new patients referred for a routine otology consultation (75 telephone, 75 face-to-face) were included. 53/75 patients (71%) undergoing a face-to-face consultation received a definitive outcome following initial review, versus 22/75 (29%) telephone patients (2 <0.001, OR 5.8). 52/75 (69%) telephone patients were followed up face-to-face for examination. The mean (SD) number of appointments required to reach a definitive outcome was 1.22 (0.58) and 1.75 (0.73) in the face-to-face and telephone cohorts respectively (p<0.001). Conclusion: Telephone clinics in otology have played an important role as part of the COVID19 response. However, they are currently limited by a lack of clinical examination and audiometry. Remote assessment pathways in otology that incorporate asynchronous review of recorded examinations alongside audiometry, either conventional or boothless, may mitigate this problem, however further research is required.

Objective: Cases of chronic otitis externa (OE) resistant to conventional treatment remain a significant challenge. This paper describes our experience of utilising fluticasone propionate (Flixonase®) drops in the treatment of such cases. Methods: We included a series of patients with resistant chronic OE that were referred to ENT consultant clinic between 2016 and 2018, all of whom failed to respond to the conventional treatments. The patients were prescribed 200 micrograms of Flixonase® once daily and followed up in the clinic to assess response to the treatment. The case notes were reviewed retrospectively. Results: Total of 25 patients identified over 2 years. Patients reported itching as the most common symptom (83%), and skin changes were the most common sign identified under examination (72%). The combination of steroid and antibiotic drops had been the most common treatment modality prescribed. Fluticasone propionate was started a median of 5 months after the diagnosis (range: 0-54 months) with a median treatment duration of 3 months (range: 1-18 months). All 17 patients who attended the follow-up clinic were classified as having been cured. Conclusions: Our findings suggest fluticasone propionate as an exciting and potentially important modality in the treatment of chronic OE cases, especially where all other treatment options have been exhausted.

Treating twenty-five cases of chronic resistant otitis externa with fluticasone propionate (Flixonase®): a case series Utilising Flixonase® in treatment of chronic otitis externaKey points:Chronic cases of otitis externa, resistant to conventional treatments are notoriously difficult to treat, with resolution in these cases challenging.Guidelines suggest the use of corticosteroid in chronic otitis externa, however, there is no specific advice on which corticosteroid to utilise.Our case-series demonstrates the potential benefit of fluticasone propionate in patients who have previously failed a multitude of conventional management options.Despite the limitations of our study, our experience highlights a gap in the literature and suggest fluticasone propionate as an exciting and potentially important tool in the arsenal of the otolaryngologist.