METHODS
2.1 Ethical Consideration:
The local research and development department has advised no need for
ethical approval as the data collection was part of an audit. All
patient data was anonymised prior to data analysis.
2.2 Study Design:
The study was performed at the University Hospital Birmingham. A
retrospective case note review was conducted of all consecutive patients
who have had a diagnosis of COE for more than 3 months between October
2016 and October 2018 and who were treated with fluticasone propionate
by single surgeon. All patients were treated with 200µg of fluticasone
propionate once daily for the affected ear. There were no modifications
of treatment dosage during the length of the study. We did not have any
exclusion criteria.
A standard protocol was designed for systematic data collection from the
clinic letters.
Patients details recorded included sex, age at the time of diagnosis,
previous treatment modalities, length of fluticasone propionate
treatment, pre- and post-treatment symptoms including otalgia,
tenderness, otorrhoea and itching, as well as signs of oedema and
inflammation, and eventual outcome of treatment. We recorded the numbers
of patients who showed resolution of symptoms after administration of
fluticasone propionate drops. The definition of symptom resolution was
to be symptom-free with a normal endoscopic view of the external
auditory canal.
Results
Data were available for a total of 25 patients, with a median age of
55±15 years, and of whom the majority were female (21/25). The most
common signs and symptoms at presentation were itching (20/25), skin
changes (16/25) and otorrhoea (15/25).
Prior to treatment with fluticasone propionate, 44% (11/25) had tried
combination of antibiotic and steroid drops, 28% (7/25) had taken
topical steroid medications, 16% (4/25) have been on antibiotic only
drops and 12% (3/25) had tried other medications, namely oral
antibiotics (Table 1, Chart 1). The fluticasone propionate was started
at a median of 5 months after diagnosis (range: 3-54), with a median
treatment duration of 3 months (range: 1-18). Follow up was between two
and eighteen months for all patients with median follow up of 6 months.
After treatment, twenty patients returned for a follow up appointment.
Of the remainder, 5 patients did not attend the planned appointment.
None of the 20 patients reported otalgia, tenderness, oedema or skin
changes, and only one patient reported itching. In summary all 20
patients who attended the follow up appointment reported symptom
resolution and they were all discharged from the clinic. None of the
patients were presented back to the clinic by the time of data
collection in June 2019.