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CPG: Acute Otitis Externa (AOE) Update – Research Needs

CPG: Acute Otitis Externa (AOE) Update – Research Needs

Research Needs section from the Acute Otitis Externa CPG


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, use an explicit double-blind protocol, and fully describe dropouts and withdrawals
  7. High-quality randomized trials assessing the benefit of systemic antimicrobial therapy versus 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 (eg, after 2-4 days of therapy) and compare time to symptom resolution in addition to categorical responses (eg, cure, improvement, failure) for specific days
  9. Comparative clinical trials of “home therapies” (eg, vinegar, alcohol) versus 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 versus no wick when administering topical therapy
  14. Comparative clinical trials of suction or active debridement of the ear canal versus 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 (eg, 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
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