Research Needs section from the Acute Otitis Externa CPG
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, use an explicit double-blind protocol, and fully describe dropouts and withdrawals
- High-quality randomized trials assessing the benefit of systemic antimicrobial therapy versus 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 (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
- Comparative clinical trials of “home therapies” (eg, vinegar, alcohol) versus 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 versus no wick when administering topical therapy
- Comparative clinical trials of suction or active debridement of the ear canal versus 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 (eg, 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
