Research Gaps - Acute Otitis Externa (AOE)
Research needs are as follows:
- 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.
- Clinical trials to determine the efficacy of topical steroids for relief of pain caused by AOE.
- Observational studies or clinical trials to determine if water precautions are necessary, or beneficial, during treatment of an active AOE episode.
- Observational studies or clinical trials to determine optimal time to discontinue water precautions for AOE.
- Increased ability to distinguish treatment failure from topical sensitivity when a patient with AOE fails to respond to topical therapy.
- 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
- High-quality randomized trials assessing the benefit of systemic antimicrobial therapy vs. topical therapy in patients stratified by severity of signs and symptoms.
- 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.
- Comparative clinical trials of "home therapies" for (e.g., vinegar, alcohol) vs. antimicrobials for treating AOE.
- Define the optimal duration of topical therapy for AOE and the role of patient preferences.
- Define with greater precision the indications for aural toilet and wick placement.
- Determine the efficacy of aural toilet as an independent factor when treating AOE.
- Comparative clinical trials of wick vs. no wick when administering topical therapy.
- Comparative clinical trials of suction or active debridement of the ear canal vs. dry mopping.
- Define the best methods of teaching clinicians, especially those in primary care settings, how to safely and effectively perform aural toilet and wick insertion.
- Determine the optimal method to assess tympanic membrane integrity in patients with AOE (e.g., what is the utility of tympanometry).
- Development of medicated wicks that gradually release drug into the ear canal.
- Continued monitoring of bacteriology and antibiotic resistance patterns in AOE.