Systematic review of the diagnosis and management of necrotising otitis externa: Highlighting the need for high‐quality research

Takata, Junko; Hopkins, Michael E.; Alexander, V; Bannister, Oliver; Dalton, Lucy; Harrison, Laura; Groves, Emily S.; Kanona, Hala; Jones, Gwennan Llwyd; Hassan, Md. Imtaiyaz; Andersson, Monique; Hodgson, Susanne H.

doi:10.1111/coa.14041

Cited by 12 publications

(18 citation statements)

References 83 publications

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“…Typical management of NOE includes systemic antibiotics and the strict control of diabetes. Surgical therapy is not usually recommended, although it can be an option for pain relief pain in refractory cases and for evacuating NOE‐related skull base abscesses 20–22 …”

Section: Discussionmentioning

confidence: 99%

Are artificial intelligence large language models a reliable tool for difficult differential diagnosis? An a posteriori analysis of a peculiar case of necrotizing otitis externa

Pugliese,

Maccari,

Felisati

et al. 2023

Clinical Case Reports

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Key Clinical MessageLarge language models have made artificial intelligence readily available to the general public and potentially have a role in healthcare; however, their use in difficult differential diagnosis is still limited, as demonstrated by a case of necrotizing otitis externa.AbstractThis case report presents a peculiar case of necrotizing otitis externa (NOE) with skull base involvement which proved diagnostically challenging. The initial patient presentation and the imaging performed on the 78‐year‐old patient suggested a neoplastic rhinopharyngeal lesion and only after several unsuccessful biopsies the patient was transferred to our unit. Upon re‐evaluation of the clinical picture, a clinical hypothesis of NOE with skull base erosion was made and confirmed by identifying Pseudomonas aeruginosa in biopsy specimens of skull base bone and external auditory canal skin. Upon diagnosis confirmation, the patient was treated with culture‐oriented long‐term antibiotics with complete resolution of the disease. Given the complex clinical presentation, we chose to submit a posteriori this NOE case to two large language models (LLM) to test their ability to handle difficult differential diagnoses. LLMs are easily approachable artificial intelligence tools that enable human‐like interaction with the user relying upon large information databases for analyzing queries. The LLMs of choice were ChatGPT‐3 and ChatGPT‐4 and they were requested to analyze the case being provided with only objective clinical and imaging data.

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Section: Discussionmentioning

confidence: 99%

Are artificial intelligence large language models a reliable tool for difficult differential diagnosis? An a posteriori analysis of a peculiar case of necrotizing otitis externa

Pugliese,

Maccari,

Felisati

et al. 2023

Clinical Case Reports

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show abstract

“…This systematic review is the first to assess antimicrobial regimens and associated clinical outcomes in necrotising otitis externa. Date restrictions were not applied, to allow a Published reviews [14][15][16][17][18] have highlighted a lack of quality research in necrotising otitis externa. Existing literature consists largely of uncontrolled, retrospective case series with high bias and low certainty of assessment results.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Published reviews 14–18 have highlighted a lack of quality research in necrotising otitis externa. Existing literature consists largely of uncontrolled, retrospective case series with high bias and low certainty of assessment results.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…The resulting heterogeneity in data prevents best practice from being defined. 18 The management of necrotising otitis externa therefore remains a challenge.…”

Section: Introductionmentioning

confidence: 99%

“…Several reviews 14,18 summarise antibiotic regimens used to manage necrotising otitis externa in published case series and highlight variation within these, but detailed analysis of these regimens and their outcomes is yet to be performed. This systematic review explores antimicrobial therapies and outcomes reported in published case series, aiming to identify the most effective approach to antimicrobial therapy in terms of medication choice, delivery method, dual versus single therapy, and empiric versus culture-guided therapy.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A systematic review of antimicrobial treatment regimens and their outcomes in necrotising otitis externa

Lodhi,

Timms,

Stapleton

2023

J. Laryngol. Otol.

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Background Necrotising otitis externa is a serious infection with minimal evidence underpinning its management. This review aims to synthesise published evidence of antimicrobial therapies and their outcomes in necrotising otitis externa. Methods The review was PROSPERO registered (CRD42022353244) and conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (‘PRISMA’) guidelines. A robust search strategy filtered 28 manuscripts into the final review. Antimicrobial therapy and clinical outcome data were extracted and analysed. Results Published studies are heterogeneous, with high risk of bias and low certainty. Reporting of outcomes is poor and extremely variable. First-line therapy is most commonly in-patient (95 per cent) empiric fluoroquinolone (68 per cent) delivered intravenously (82 per cent). The lack of granular data and poor outcome reporting mean it is impossible to correlate treatment strategies with clinical outcomes. Conclusion Robust, consistent outcome reporting with reference to treatments administered is mandatory, to inform clinical management and optimise future research. Optimal antimicrobial choices and treatment strategies require clarification through prospective clinical trials.

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Epidemiology and risk factors for extension of necrotizing otitis externa

Krawiec,

Brenet,

Truong

et al. 2024

Eur Arch Otorhinolaryngol

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Systematic review of the diagnosis and management of necrotising otitis externa: Highlighting the need for high‐quality research

Cited by 12 publications

References 83 publications

Are artificial intelligence large language models a reliable tool for difficult differential diagnosis? An a posteriori analysis of a peculiar case of necrotizing otitis externa

Are artificial intelligence large language models a reliable tool for difficult differential diagnosis? An a posteriori analysis of a peculiar case of necrotizing otitis externa

A systematic review of antimicrobial treatment regimens and their outcomes in necrotising otitis externa

Epidemiology and risk factors for extension of necrotizing otitis externa

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