Introduction: Referrals for OE have increased but the reasons for this remain unclear. We characterise referrals to inform primary secondary care interface improvements. Methods: Questionnaire study from dedicated consultant-led research clinic for OE referrals. Results: 62 patients responded; 63% female, mean age 54 years. One was excluded (not OE). Most had multiple primary care visits before referral (average 4 GP; 2 practice nurse). 60% had received oral antibiotics (16% multiple classes). 18% had never had ear drops. 39% were not advised to keep ears dry. 21% had dermatitis; 13% contact allergy, 30% systemic allergy, 5% diabetes. <10% had narrow canals. 36% had active discharge but <7% needed a wick. Conclusion: OE occurs most commonly in women - often with associated risk factors. Lifestyle advice and ototopical drops are frequently overlooked; instead often inappropriately treated with oral antibiotics. Most ear were anatomically normal and community aural care clinics may have a role in reducing referrals.

Introduction Sudden sensorineural hearing loss (SSNHL) management is controversial. Systemic steroids as treatment is the most recommended. British society of otology advised caution when prescribing systemic steroids during COVID-19 crisis. As a result, intratympanic steroids (ITS), seem to offer an alternative. Methods: Number of performed MRI scans for investigation of SSNHL between 01/01/2019 and 31/12/2019. This was used as a surrogate measure, reflecting the number of patients with SSNHL over that 12 months period. All patients who were diagnosed and treated for SSNHL between the 16th of March 2020 and the 8th of July 2020 were included in this study. Clinical outcomes included time interval between onset of SSNHL and start of treatment, response to treatment and side effects Results: In 2019, only 10 scan s for SSNHL were done. Twelve patients presented with SSNHL during 4 months of COVID-19 crisis (16 weeks). Three patients had dead ear on presentation with almost no response to steroids. Conclusion The prevalence of SSNHL in time of COVID-19 pandemic appears to be higher than that before the pandemic. ITS appears to be a safe, feasible and relatively effective method of SSNHL treatment during COVID-19 pandemic. Shared decision-making with the patient is central to any intervention, especially with lack of robust evidence.