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: Necrotising otitis externa (NOE) is a severe infection of the external auditory canal and the incidence in the UK has risen dramatically in recent years. Treatment options for NOE remain contentious and can confer substantial risks. Osteomyelitis at other anatomical sites has shown promising outcomes when treated with early debridement and short-course antimicrobial therapy. Application of this paradigm in NOE may offer distinct advantages for patients but this remains to be demonstrated. Methods: A prospective cohort analysis of patients with NOE admitted to Sunderland Royal Hospital between January-September 2019. Previous treatment, examination findings, medical history, relevant microbiology and imaging results were document. Results: A total of eight patients were included (age 58-87, male:female 6:2). Most (6/8) patients had type 2 diabetes; 5/6 had poor glycaemic controls (HbA1c > 48mmol/mol). 4/8 patients had undergone previous ear syringing. Pain was present on average for 40 days prior to admission (range 14-60 days). Otoscopy and CT findings were highly variable between cases. Most (5/8) patients grew P. aeruginosa on bacterial swabs. 5/8 patients were treated with short course antimicrobial therapy (3/8 prolonged). 5/8 received early surgical debridement. 7/8 patients were successfully treated – 1 patient died of concurrent haematological malignancy. Conclusion: A standardised protocol for NOE has facilitated a consistent approach to treatment at our centre. Selected cases have good outcomes with short course antimicrobial therapy and early surgical debridement, but this analysis was not powered to determine statistical significance. A randomised trial with more patients would confirm non-inferiority of short course antimicrobial therapy and early surgical debridement in NOE.