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.