Research Gaps - Acute Otitis Externa (AOE)

Research Gaps - Acute Otitis Externa (AOE)

Research needs are as follows: 

  1. RCTs of absolute and comparative clinical efficacy of ototopical therapy of uncomplicated AOE in primary care settings, including the impact of aural toilet on outcomes.
  2. Clinical trials to determine the efficacy of topical steroids for relief of pain caused by AOE.
  3. Observational studies or clinical trials to determine if water precautions are necessary, or beneficial, during treatment of an active AOE episode.
  4. Observational studies or clinical trials to determine optimal time to discontinue water precautions for AOE.
  5. Increased ability to distinguish treatment failure from topical sensitivity when a patient with AOE fails to respond to topical therapy.
  6. High-quality randomized trials of comparative clinical efficacy for AOE that use an appropriate randomization scheme, explicit double-blind protocol, and fully describe dropouts and withdrawals
  7. High-quality randomized trials assessing the benefit of systemic antimicrobial therapy vs. topical therapy in patients stratified by severity of signs and symptoms.
  8. High-quality randomized trials of comparative clinical efficacy for AOE that provide clinical outcomes early in the course of therapy (e.g., after 2-4 days of therapy) and compare time to symptom resolution in addition to categorical responses (e.g., cure, improve, failure) for specific days.
  9. Comparative clinical trials of "home therapies" for (e.g., vinegar, alcohol) vs. antimicrobials for treating AOE.
  10. Define the optimal duration of topical therapy for AOE and the role of patient preferences.
  11. Define with greater precision the indications for aural toilet and wick placement.
  12. Determine the efficacy of aural toilet as an independent factor when treating AOE.
  13. Comparative clinical trials of wick vs. no wick when administering topical therapy.
  14. Comparative clinical trials of suction or active debridement of the ear canal vs. dry mopping.
  15. Define the best methods of teaching clinicians, especially those in primary care settings, how to safely and effectively perform aural toilet and wick insertion.
  16. Determine the optimal method to assess tympanic membrane integrity in patients with AOE (e.g., what is the utility of tympanometry).
  17. Development of medicated wicks that gradually release drug into the ear canal.
  18. Continued monitoring of bacteriology and antibiotic resistance patterns in AOE.