ABSTRACT
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.
ABSTRACT
AIM: Nationally, concern has been raised about the overuse of diagnostic testing. In patients with unilateral otalgia and no history of Head and Neck Cancer (HNC), 1% had a malignancy detected on imaging that was not detected on clinical examination. METHODS: We performed a retrospective review of "MRI soft tissue neck" scans performed at our hospital from May 2020 to May 2021. Patients were excluded if their scan was not ordered for HNC symptoms. Previous HNC patients undergoing follow-up imaging were also included. RESULTS: In total, 326 scan requests were analyzed. Of the 132 patients without clinical features of overt disease, only one received a new diagnosis of HNC. This patient had previously had a HNC and was undergoing routine follow-up imaging. CONCLUSION: Our data demonstrate that performing MRI scans in symptomatic patients with a normal examination, FNE, and no history of HNC does not benefit the diagnosis or management of these patients.
Subject(s)
Head and Neck Neoplasms , Head and Neck Neoplasms/diagnostic imaging , Humans , Magnetic Resonance Imaging , Physical Examination , Retrospective StudiesABSTRACT
We report a case of a 54-year-old woman with saline-based breast implants who presented to the ear, nose and throat neck lump clinic with a 2-week history of bilateral neck lumps. She was found to have multiple palpable cervical lymph nodes bilaterally in levels IV and Vb. The ultrasonography demonstrated multiple lymph nodes with the snowstorm sign and a core biopsy confirmed a silicone granuloma (siliconoma). This granuloma was likely caused by bleeding gel from the silicone shell of her saline-based implants. This case demonstrates the importance of bleeding gel from saline-based implants, in the absence of implant rupture. Thus, head and neck specialists should consider siliconomas as a cause for cervical lymphadenopathy in patients with saline-based breast implants.
