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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Wiegand S, Berner R, Schneider A, Lundershausen E, Dietz A. Otitis Externa. [Review]. Deutsches Arzteblatt International. 116(13):224-234, 2019 03 29. Review/Other-Dx N/A To review publications retrieved by a selective search of the pertinent literature. The treatment of acute otitis media consists of anal- gesia, cleansing of the external auditory canal, and the appli- cation of antiseptic and antimicrobial agents. Local antibiotic and corticosteroid preparations have been found useful, but there have been no large-scale randomized controlled trials of their use. Topical antimicrobial treatments lead to a higher cure rate than placebo, and corticosteroid preparations lessen swelling, erythema, and secretions. Oral antibiotics are indi- cated if the infection has spread beyond the ear canal or in patients with poorly controlled diabetes mellitus or immuno- suppression. Chronic otitis externa is often due to an under- lying skin disease. Malignant otitis externa, a destructive infection of the external auditory canal in which there is also osteomyelitis of the petrous bone, arises mainly in elderly diabetic or immunosuppressed patients and can be life- threatening. 4
2. Spielmann PM, Yu R, Neeff M. Skull base osteomyelitis: current microbiology and management. J Laryngol Otol. 127 Suppl 1:S8-12, 2013 Jan. Observational-Dx 20 patients To evaluate the ability of preoperative mastoid high resolution Computerized tomography (CT Scan) fusion with the postoperative diffusion weighted magnetic resonance imaging (Non-EPI DWI) to accurately localize the residual cholesteatoma thus sparing an unnecessary postoperative CT scan radiation. Twenty patients were identified. A facial palsy was present in 12 patients (60 per cent). Blood cultures were uniformly negative, and culture of ear canal granulations was non-diagnostic in 71 per cent of cases. Pseudomonas aeruginosa was isolated in only 10 (50 per cent) cases; one strain was resistant to ciprofloxacin but all were sensitive to ceftazidime. Two cases of fungal skull base osteomyelitis were identified. The mortality rate was 15 per cent. The patients' treatment algorithm is presented. 4
3. Trevino Gonzalez JL, Reyes Suarez LL, Hernandez de Leon JE. Malignant otitis externa: An updated review. [Review]. American Journal of Otolaryngology. 42(2):102894, 2021 Mar-Apr. Review/Other-Dx N/A To review the most recent studies on epidemiology, clinical manifestations, diagnosis, and treatment to provide an update on Malignant Otitis Externa that can offer an overview for clinical practice and future research. No results stated in the abstract. 4
4. Chawdhary G, Pankhania M, Douglas S, Bottrill I. Current management of necrotising otitis externa in the UK: survey of 221 UK otolaryngologists. Acta Oto-Laryngologica. 137(8):818-822, 2017 Aug. Review/Other-Dx N/A To report the experience of 221 otolaryngologists in this condition. Respondents' detailed replies on diagnosis, treatment and follow up are presented. One third of respondents reported increasing incidence of NOE. Over 80% diagnosed NOE based on pre-existing risk factors, severe pain, non-resolution of infection and CT scan. Most respondents managed NOE with intravenous antibiotics (90%) and blood sugar control (82%). There was less agreement in certain aspects of management including the role of surgery and the nature and duration of follow up. 4
5. Pont E, Mazon M. Indications and radiological findings of acute otitis media and its complications. Acta Otorrinolaringologica Espanola. 68(1):29-37, 2017 Jan - Feb. Review/Other-Dx N/A To review the clinical and radiological features of acute otitis media and its complications. No results stated in the abstract. 4
6. Luntz M, Bartal K, Brodsky A, Shihada R. Acute mastoiditis: the role of imaging for identifying intracranial complications. Laryngoscope. 122(12):2813-7, 2012 Dec. Observational-Dx 71 patients To aim at characterizing the typical clinical presentation of patients who already have intracranial complications (ICCs) when diagnosed with AM, and to compare it to that of AM patients presenting without ICCs. Of 71 patients presenting with AM, 10 had at least one ICC (sigmoid sinus thrombosis [nine patients], perisinus empyema [five patients], subdural abscess [one patient], and epidural abscess [one patient]). Patients with and without ICCs did not differ regarding most clinical characteristics or presenting signs and symptoms. None presented with neurological signs or cranial nerve deficits. 2
7. Marom T, Roth Y, Boaz M, et al. Acute Mastoiditis in Children: Necessity and Timing of Imaging. Pediatr Infect Dis J. 35(1):30-4, 2016 Jan. Observational-Dx 86 patients To study the reasons leading to the performance of an imaging study during Acute mastoiditis (AM) course. Eighty-six children were diagnosed with 88 AM episodes. Of the AM episodes, 55 (63%) were in boys and 46 (52%) were in children younger than 2 years. All children were treated with parenteral antibiotics, and 82 (95%) underwent myringotomy on admission. Only 20 (23%) children underwent imaging studies, on the 6th median day. Of those, 20 (100%) children underwent CT scans, and 3 (15%) underwent additional MRI studies. The reasons for imaging studies included suspected subperiosteal abscess (9 of 20, 45%), lack of improvement despite adequate medical therapy (7, 35%) and focal neurological signs (4, 20%). Sixteen (16%) children underwent surgery for these pathologies: subperiosteal abscesses (n = 12,), jugular vein thrombosis (n = 2), perisinus empyema (n = 2), epidural abscess (n = 2) and Luc abscess (n = 1). 2
8. Mather M, Powell S, Yates PD, Powell J. Acute mastoiditis in children: contemporary opportunities and challenges. Journal of Laryngology & Otology. 134(5):434-439, 2020 May. Observational-Dx 51 patients To conduct a review of children diagnosed with mastoiditis at a tertiary referral centre, in North East England, between 2010 and 2017. Fifty-one cases were identified, 49 without cholesteatoma. Median patient age was 42 months (2 months to 18 years) and median hospital stay was 4 days (range, 0-27 days). There was no incidence trend over time. Imaging was conducted in 15 out of 49 cases. Surgery was performed in 29 out of 49 cases, most commonly mastoidectomy with (9 out of 29) or without (9 out of 29) grommets. Complications included sigmoid sinus thrombosis (3 out of 49) and extradural abscess (2 out of 51), amongst others; no fatalities occurred. 2
9. Saat R, Kurdo G, Brandstack N, Laulajainen-Hongisto A, Jero J, Markkola A. A New Classification System is Helpful in Diagnosing Intracranial Complications of Acute Mastoiditis in CT. Clin Neuroradiol. 28(4):523-528, 2018 Dec. Observational-Dx 5 patients o assess the usefulness of the new computed tomography (CT) classification criteria proposed by Horowitz et al. and their effect on inter-observer agreement when estimating intracranial complications of acute mastoiditis. With the old method, epidural abscesses were suspected in six and venous sinus thrombosis in five patients. With the new method, high-risk perisinuous lesions (classes III or IV) were detected in 11 patients, and sinus thrombosis outside the perisinuous area in 3 patients. All epidural abscesses were in the perisinuous area. Of the patients four, in whom intracranial pathology was not suspected with the old method, fell into the high-risk group (class III) according to the new method. All class IV lesions were also determined to be pathological with the old method. The inter-observer agreement (weighted kappa) rose from 0.21 (old method) to 0.80 (new method) when assessing epidural abscesses and from 0.44 (old method) to 0.85 (new method) when assessing sinus thrombosis. 2
10. Paltura C, Can TS, Yilmaz BK, Dinc ME, Develioglu ON, Kulekci M. Eustachian tube diameter: Is it associated with chronic otitis media development?. Am J Otolaryngol. 38(4):414-416, 2017 Jul - Aug. Observational-Dx 232 patients To evaluate the effect of ET diameter on Chronic Otitis Media (COM) pathogenesis. 154 (76 (49%) male, 78 (51%) female patients were diagnosed with unilateral COM and included in the study. The mean diameter of ET was 1947mm (Std. deviation±0.5247) for healthy ears and 1788mm (Std. deviation±0.5306) for diseased ears. The statistical analysis showed a significantly narrow ET diameter in diseased ear side (p<0.01). 2
11. Yamashita K, Yoshiura T, Hiwatashi A, et al. Contributing factors in the pathogenesis of acquired cholesteatoma: size analysis based on MDCT. AJR Am J Roentgenol. 196(5):1172-5, 2011 May. Observational-Dx 50 patients To explore the factors that contribute to the occurrence of cholesteatoma. We studied the size of the mastoid air cells and the tympanic cavity using high-resolution CT. One hundred temporal bones of 50 patients with cholesteatoma and 50 control subjects were included. Both the volume and the cross-sectional area of the cavities of the combined mastoid air cells and tympanic cavity in the affected side of the patients with cholesteatoma were significantly smaller than those in the unaffected side (p < 0.001). Moreover, both the volume and the cross-sectional area of the cavities of the combined mastoid air cells and tympanic cavity in both affected and unaffected sides of patients with cholesteatoma were significantly smaller than those in control subjects (p < 0.001). The volume of the cavities of the mastoid air cells in the unaffected side of patients with cholesteatoma was smaller than that of the control subjects (p < 0.001). In contrast, no significant difference was found in the tympanic cavity volume between the unaffected side and the control subjects. 1
12. Smith ME, Hardman JC, Mehta N, et al. Acute otitis externa: Consensus definition, diagnostic criteria and core outcome set development. PLoS ONE [Electronic Resource]. 16(5):e0251395, 2021. Observational-Dx 9 patients To develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for acute otitis externa (AOE). Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was 'diffuse inflammation of the ear canal skin of less than 6 weeks duration'. 2
13. Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical practice guideline: acute otitis externa. [Review]. Otolaryngology - Head & Neck Surgery. 150(1 Suppl):S1-S24, 2014 Feb. Review/Other-Dx N/A To promote appropriate use of oral and topical antimicrobials for AOE and to highlight the need for adequate pain relief. The development group made strong recommendations that (1) clinicians should assess patients with AOE for pain and recommend analgesic treatment based on the severity of pain and (2) clinicians should not prescribe systemic antimicrobials as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy. The development group made recommendations that (1) clinicians should distinguish diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the external ear canal; (2) clinicians should assess the patient with diffuse AOE for factors that modify management (nonintact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, prior radiotherapy); (3) clinicians should prescribe topical preparations for initial therapy of diffuse, uncomplicated AOE; (4) clinicians should enhance the delivery of topical drops by informing the patient how to administer topical drops and by performing aural toilet, placing a wick, or both, when the ear canal is obstructed; (5) clinicians should prescribe a non-ototoxic preparation when the patient has a known or suspected perforation of the tympanic membrane, including a tympanostomy tube; and (6) clinicians should reassess the patient who fails to respond to the initial therapeutic option within 48 to 72 hours [corrected] to confirm the diagnosis of diffuse AOE and to exclude other causes of illness. 4
14. Spielmann PM, McKean S, White RD, Hussain SS. Surgical management of external auditory canal lesions. Journal of Laryngology & Otology. 127(3):246-51, 2013 Mar. Review/Other-Dx N/A To describe a 10-year personal case series of external auditory canal lesions with chart, imaging and histopathology review. In total, 48 lesions required surgical management, consisting of: 13 bony lesions; 14 infective lesions; 14 neoplasms with 11 histological types (including ceruminous adenoma and the extremely rare cavernous haemangioma); 3 epithelial abnormalities; and 4 other benign lesions. The surgical management is described. 4
15. Cooper T, Hildrew D, McAfee JS, McCall AA, Branstetter BF 4th, Hirsch BE. Imaging in the Diagnosis and Management of Necrotizing Otitis Externa: A Survey of Practice Patterns. Otol Neurotol. 39(5):597-601, 2018 06. Review/Other-Dx 36 patients To survey neurotologists and head and neck radiologists regarding use of imaging in the diagnosis and management of necrotizing otitis externa (NOE). One hundred thirty-six participants responded to the survey. The imaging modality of choice in establishing the diagnosis of NOE selected by the respondents was computed tomography (CT) (37.5%) followed by technetium scintigraphy (21.3%). Magnetic resonance imaging (MRI) was the preferred investigation by 41.9% of participants for determining extent of disease. Gallium scanning was the imaging modality preferred by 32.4% of respondents for determining when to cease medical therapy. Ninety-five percent of participants responded that CT scans were always or frequently used in the diagnosis and management of NOE compared with 72.8% for MRI, 34.5% for gallium scans, and 34.2% for technetium scans. 4
16. Lambor DV, Das CP, Goel HC, Tiwari M, Lambor SD, Fegade MV. Necrotising otitis externa: clinical profile and management protocol. J Laryngol Otol. 127(11):1071-7, 2013 Nov. Observational-Dx 27 patients To frame a protocol for management based on clinical parameters. Out of 27 patients, 26 were diabetics. The commonest organism isolated was P aeruginosa, which was sensitive to third generation cephalosporins and fluoroquinolones. Nine patients had cranial nerve involvement. Twelve of 15 patients treated with medical therapy recovered, as did 11 of 12 patients that underwent surgery. 4
17. Bhat V, Aziz A, Bhandary SK, Aroor R, Kamath P SD, Saldanha M. Malignant Otitis Externa - A Retrospective Study of 15 Patients Treated in a Tertiary Healthcare Center. The Journal of International Advanced Otology. 11(1):72-6, 2015 Apr. Observational-Dx 15 patients To evaluate the demographic profile, coexisting disabilities, clinical presentations, and management of Malignant otitis externa (MOE). Fifteen patients with MOE were treated as inpatients at the Otorhinolaryngology Department of our hospital during the study period. Of these, 12 were males and three were females. Among the 15 patients, 14 were diabetic and one was non-diabetic. Earache was the most common symptom observed in all patients; edema and granulations in the ear canal was the most common sign observed in 12 patients. Pseudomonas aeruginosa was isolated in 11 patients. All patients were managed medically with intravenous antibiotics. 4
18. Bock K, Ovesen T. Optimised diagnosis and treatment of necrotizing external otitis is warranted. Dan Med Bull. 58(7):A4292, 2011 Jul. Review/Other-Dx 11 patients To evaluate the diagnostics and treatment of NEO and to recommend new guidelines. The median age was 75 years and the median time of therapy at the hospital was 6.3 months. All patients belonged to a risk group. A diagnostic delay was found resulting in further progression of the disease. In contrast to current international recommendations, the treatment consisted mostly of local antibiotics in combination with surgery. All patients survived, but most patients were left with hearing loss and psychiatric problems. 4
19. Auinger AB, Dahm V, Stanisz I, Schwarz-Nemec U, Arnoldner C. The challenging diagnosis and follow-up of skull base osteomyelitis in clinical practice. Eur Arch Otorhinolaryngol. 278(12):4681-4688, 2021 Dec. Review/Other-Dx 30 patients To review the chart of the challenging diagnosis and follow-up of skull base osteomyelitis in clinical practice The overall mortality rate was 36.7% and increased to 45% when cranial nerve palsies were present. An initial computed tomography (CT) scan was performed in all patients, MRI in 60% and nuclear imaging in 33%. CT scans failed to detect progression or regression in up to 80% after four to nine months. MRI examinations could reveal changes at a higher rate compared to CT. Nuclear medicine functional imaging was most likely to assess disease activity. 4
20. Kamalden TMIT, Misron K. A 10-year review of malignant otitis externa: a new insight. European Archives of Oto-Rhino-Laryngology. 279(6):2837-2844, 2022 Jun. Observational-Dx 49 patients To assess the clinical trends of malignant otitis externa (MOE) and classify MOE based on the findings related to high-resolution computed tomography (HRCT) of the temporal bone and 99-Tech3-Phase Bone Scintigraphy (TPBS). We also reconstruct a treatment algorithm for MOE in our institution. A sample of 49 patients was involved in this study. Majority of the patients were having Phase III (36.7%) of the disease, followed by Phase V (24.5%), Phase II (18.4%), Phase IV (16.3%), and Phase I (4.1%). A comprehensive treatment algorithm was drafted based on our institution's experience in managing MOE. The mortality rate was low (8.2%), mainly involving patients in advanced phase of the disease (Phases IV and V). 2
21. Hodgson SH, Sinclair VJ, Arwyn-Jones J, et al. Characteristics, management and outcome of a large necrotising otitis externa case series: need for standardised case definition. J Laryngol Otol. 136(7):604-610, 2022 Jul. Observational-Dx 58 patients To describe clinical characteristics, management and outcomes for patients managed as necrotising otitis externa cases at a UK tertiary referral centre. A total of 58 (63 per cent) patients were classified as definite necrotising otitis externa cases, 31 (34 per cent) as probable cases and 3 (3 per cent) as possible cases. Median duration of intravenous and oral antimicrobial therapy was 6.0 weeks (0.49-44.9 weeks). Six per cent of patients relapsed a median of 16.4 weeks (interquartile range, 23-121) after stopping antimicrobials. Twenty-eight per cent of cases had complex disease. These patients were older (p = 0.042), had a longer duration of symptoms prior to imaging (p < 0.0001) and higher C-reactive protein at diagnosis (p = 0.005). Despite longer courses of intravenous antimicrobials (23 vs 14 days; p = 0.032), complex cases were more likely to relapse (p = 0.016). 2
22. Lim JWJ, Hill FCE, Kerr S, Briggs R, McLean T. Diagnostic approach to patients at risk of otogenic skull base osteomyelitis. Acta Otolaryngol (Stockh). 142(3-4):272-279, 2022 Mar-Apr. Observational-Dx 103 patients To review a single institution's high-volume experience of OSBO, with the aim of analysing clinicopathologic features and imaging studies to develop a diagnostic algorithm. HbA1c = 7% significantly predicted for OSBO in univariate (OR 7.83, 95% CI 1.85-33.16, p = 0.01) and multivariate analyses (OR 5.21, 95% CI 1.05-25.81, p = 0.04). The CT/technetium-99m/gallium-67 combination produced better diagnostic accuracy for OSBO (AUROC 0.96, 95% CI 0.92-1), when compared to a CT/MRI combination (AUROC 0.86, 95% CI 0.79-0.93). 2
23. Balakrishnan R, Dalakoti P, Nayak DR, Pujary K, Singh R, Kumar R. Efficacy of HRCT Imaging vs SPECT/CT Scans in the Staging of Malignant External Otitis. Otolaryngol Head Neck Surg. 161(2):336-342, 2019 08. Review/Other-Dx 28 patients To conduct a clinical chart with medical records and radiologic images. Out of 28 patients included in this study, 72% had SPECT/CT scans showing higher staging than the HRCT imaging. Four patients had mild uptake (stage 1), and 15 had disease confined to the mastoid/temporal bone, not reaching midline (stage 2). All patients in stages 1 and 2 were surviving with good symptom control. Five patients with petrous involvement reaching midline (stage 3) had persistent symptoms, and all 4 cases with SPECT/CT showing sphenoid involvement and crossing midline (stage 4) died within a year of diagnosis. 4
24. Lau K, Scotta G, Wu K, Kabuli MAK, Watson G. A review of thirty-nine patients diagnosed with necrotising otitis externa over three years: Is CT imaging for diagnosis sufficient?. Clin Otolaryngol. 45(3):414-418, 2020 05. Observational-Dx 39 patients To review  thirty-nine patients diagnosed with necrotising otitis externa over three years. No results stated in the abstract. 2
25. Hopkins ME, Bennett A, Henderson N, MacSween KF, Baring D, Sutherland R. A retrospective review and multi-specialty, evidence-based guideline for the management of necrotising otitis externa. [Review]. J Laryngol Otol. 134(6):487-492, 2020 Jun. Review/Other-Dx N/A To integrate current evidence and data from our own retrospective case series in order to develop a guideline to optimise necrotising otitis externa patient management. Prevalent presenting signs, symptoms and patient demographic data were established. Furthermore, features of cases associated with adverse outcomes were defined. A key feature of the guideline is defining at-risk patients with initial intensive treatment. Investigations and outcomes are assessed and treatment adjusted appropriately. 4
26. Peled C, Novoa R, El-Saied S, Sadeh R, Novack V, Kaplan DM. Computer tomography findings in necrotizing otitis externa based on the offending pathogens. Eur Arch Otorhinolaryngol. 278(12):4707-4713, 2021 Dec. Observational-Dx 20 patients To compare the extension of disease, as seen on HRTBCT, in patients with NOE caused by different pathogens and (2) assess whether radiological findings may suggest the offending pathogen in cases of sterile-NOE. All patients in the fungal-NOE group complained of otalgia, compared to nine in the sterile-NOE and six in the PA-NOE groups (p value = 0.044). External ear canal edema and granulation tissue were the most common findings in all groups. Surgery was performed in five patients in the fungal-NOE and PA-NOE and three in the sterile-NOE group (p value = > 0.05). Radiological findings indicating severe bone erosion within the EEC was seen in all patients but 3 (p value = > 0.05). Severe TMJ erosion was seen in one patient within the fungal-NOE and PA-NOE group (p value = > 0.05). When mild and severe involvement were combined, TMJ bone erosion was seen in four patients in the fungal-NOE and only in one patient in the PA-NOE (p = 0.04). 2
27. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 131(3):e964-99, 2013 Mar. Review/Other-Dx N/A To discuss the diagnosis and management of acute otitis media. No results stated in the abstract. 4
28. Khan HA. Necrotising Otitis Externa: A Review of Imaging Modalities. [Review]. Cureus. 13(12):e20675, 2021 Dec. Review/Other-Dx N/A To examine tegmen height in patients with iatrogenic dural exposure in chronic otitis media (COM) surgery. No results stated in the abstract. 4
29. Chesney J, Black A, Choo D. What is the best practice for acute mastoiditis in children?. [Review]. Laryngoscope. 124(5):1057-8, 2014 May. Review/Other-Dx N/A To discuss the best practice for acute mastoiditis in children. No results stated in the abstract. 4
30. Mattos JL, Colman KL, Casselbrant ML, Chi DH. Intratemporal and intracranial complications of acute otitis media in a pediatric population. International Journal of Pediatric Otorhinolaryngology. 78(12):2161-4, 2014 Dec. Review/Other-Dx 109 patients To review all cases intratemporal and intracranial complications of acute otitis media (AOM) in infants and children from 1998 to 2013. In our population, complications included mastoiditis (86.1%), subperiosteal abscess (38%), facial nerve palsy (16.7%), sigmoid sinus thrombosis (8.3%) and epidural abscess (7.4%). Other complications included post-auricular cellulitis, otic hydrocephalus and elevated intracranial pressure, internal jugular thrombosis, cranial nerve VI palsy and Gradenigo's syndrome, labyrinthine fistula, sensorineural hearing loss, and cerebellar infarct. Sixty-one patients (56%) received antibiotics prior to presentation. Cultures revealed Streptococcus pneumoniae in 36 patients (33.3%), other bacteria in 30 patients (27.8%), and "no growth" in 33 patients (30.5%). Nine patients (8.3%) did not undergo culture. Of the patients with S. pneumoniae, 20 cultures (55%) were found to be multidrug-resistant. Eleven patients (10.2%) were treated non-surgically, 31 (31%) were treated with myringotomy and intravenous antibiotics. Forty patients (97.5%) presenting with subperiosteal abscess required mastoid surgery. Thirteen of 18 (72.2%) patients with facial paralysis had full recovery. Eight of 10 (80%) patients with epidural abscess empyema required mastoid surgery and incision and drainage of the abscess. 4
31. Ovnat Tamir S, Shemesh S, Oron Y, Marom T. Acute otitis media guidelines in selected developed and developing countries: uniformity and diversity. Archives of Disease in Childhood. 102(5):450-457, 2017 05. Review/Other-Dx N/A To study the differences and similarities between these protocols in developing and developed countries. Paediatric societies publish guidelines in most developed countries; in developing countries, the Ministry of Health usually initiates guideline formulation. Most guidelines use the same diagnostic criteria and offer watchful waiting in mild-moderate scenarios. Amoxicillin is the suggested first-line antibiotic, whereas options for second-line and third-line therapies vary. Duration of therapy varies and is usually age dependent: 5-7 days for children <2 years and 10 days for children >2 years in developed countries, while duration and age groups vary greatly in developing countries. Reduction of AOM risk factors is encouraged in developed countries, but rarely in developing countries. 4
32. Palma S, Bovo R, Benatti A, et al. Mastoiditis in adults: a 19-year retrospective study. Eur Arch Otorhinolaryngol. 271(5):925-31, 2014 May. Observational-Dx 62 patients To review retrospectively the clinical, radiological and therapeutic findings in 62 adults with acute mastoiditis treated at the ENT Department of Ferrara from 1992 to 2010. 62 adult cases fulfilled the following inclusion criteria: otoscopical evidence of co-existent or recent otitis media; postauricular swelling, erythema or tenderness; protrusion of the auricle; fever and/or significant radiological findings of mastoiditis. No results stated in the abstract. 2
33. Venekamp RP, Schilder AGM, van den Heuvel M, Hay AD. Acute otitis media in children. BMJ. 371:m4238, 2020 11 18. Review/Other-Dx N/A To discuss acute otitis media in children No results is stated in the abstract. 4
34. Hayashi T, Kitamura K, Hashimoto S, et al. Clinical practice guidelines for the diagnosis and management of acute otitis media in children-2018 update. Auris, Nasus, Larynx. 47(4):493-526, 2020 Aug. Review/Other-Dx N/A To provide appropriate recommendations about the diagnosis and management of children with acute otitis media (AOM), including recurrent acute otitis media (recurrent AOM), in children under 15 years of age. We have proposed guidelines for disease severity-based management of AOM patients, after classifying AOM severity into mild, moderate, and severe, based on age, clinical manifestations, and otoscopic findings. 4
35. Elibol E, Baran H. Evaluation of the relationship of chronic otitis media with the Korner's septum, auditory tube angle, and tubotympanic angle. Surg Radiol Anat. 43(7):1179-1186, 2021 Jul. Review/Other-Dx 210 patients To evaluate the relationships between chronic otitis media (COM) and the characteristics of Auditory tube (Eustachian) angle (ATa), tubotympanic angle (TTa), and Körner's septum (KS). There were 113 (53.81%) males and 97 (46.19%) females in the study group, and the mean age of the patients was 42.05 ± 10.77 years. The frequency of the KS was significantly higher in patients who were diagnosed with COM (35.66% vs. 7.41%, p < 0.001). The patients diagnosed with COM were found to have a narrower ATa and a wider TTa than the patients who were not diagnosed with COM. ATa was narrower and TTa was wider in patients with KS. The presence of KS and higher TTa value were considered as risk factors for COM (p < 0.001, p < 0.001, respectively) CONCLUSION: Our findings indicate that ATa was narrower, TTa was wider and KS was more frequent in patients with COM. Analysis of risk factors demonstrated that increased TTa and the presence of KS were associated with increased risk for COM. 4
36. Tatlipinar A, Tuncel A, Ogredik EA, Gokceer T, Uslu C. The role of computed tomography scanning in chronic otitis media. Eur Arch Otorhinolaryngol. 269(1):33-8, 2012 Jan. Observational-Dx 50 patients To determine the role of high-definition computed tomography (CT) in chronic otitis media (COM) patients and to present which parameters were useful or misleading for preoperative evaluation for management Fifty cases of COM that underwent preoperative CT scanning at a tertiary referral center were retrospectively analyzed. Their CT scan reports were compared with the operative findings. The patients had undergone tympanoplasty with or without mastoidectomy for COM between April 2008 and January 2010. Patient charts were used to obtain the necessary data. In 62% (31/50) of cases, the CT scan showed the presence of cholesteatoma. Operative findings revealed cholesteatoma in 61.8% (19/31) of these cases. However, when a bone eroding soft tissue mass involved the epitympanum on CT, the presence of cholesteatoma was observed in 83.3% (15/18) of cases intraoperatively. Cholesteatoma was present in the mastoid or middle ear intraoperatively in 77.7% (7/9) of patients with an external ear bony canal defect found on CT. Despite 89.7, 85.29, and 90% agreement ratios for dehiscence of facial canal, lateral semicircular canal, and tegmen, respectively, CT could not detect dehiscence of these anatomic structures successfully. Based on these results, CT scanning has limitations but is a useful adjunct for the surgical management of COM patients. 2
37. Zanoletti E, Cazzador D, Faccioli C, Sari M, Bovo R, Martini A. Intracranial venous sinus thrombosis as a complication of otitis media in children: Critical review of diagnosis and management. International Journal of Pediatric Otorhinolaryngology. 79(12):2398-403, 2015 Dec. Observational-Dx N/A To analyze the clinical presentation, management and outcome of LST in children, investigating a possible correlation between clinical aspects, radiological findings and anatomical variations. All patients had a history of otitis media at diagnosis and 4/8 presented also with more than one neurological sign or symptom. Mastoiditis signs were detected in 5/8 patients. Thrombosis was diagnosed by computed tomography, enhanced magnetic resonance and magnetic resonance venography. Treatment was medical, alone or combined with surgery. Medical treatment consisted in anticoagulants eventually combined with anti-edema medication on clinical basis. Mastoidectomy and/or myringotomy±trans-tympanic drainage placement were performed in 7/8 patients. Complete vessel recanalization was obtained in 6/8 children after a median follow-up time of 4.8 months. No complications, neither clinical sequelae occurred. In our series, neurological signs and symptoms were significantly associated with the presence of hypoplasia of the contralateral venous sinus (p=0.029). 4
38. Saat R, Mahmood G, Laulajainen-Hongisto A, et al. Comparison of MR imaging findings in paediatric and adult patients with acute mastoiditis and incidental intramastoid bright signal on T2-weighted images. Eur Radiol. 26(8):2632-9, 2016 Aug. Observational-Dx 35 adults To compare MR imaging features in patients with incidental mastoid T2-hyperintensity with those of clinical acute mastoiditis, to ascertain characteristic differences between them. Incidental mastoid T2-hyperintensity that covered = 50 % of the mastoid volume was found in 4.6 % of reviewed MR scans (n = 2341), and associated significantly (p < 0.05) less with the involvement of the tympanic cavity (38 % vs. 74 %) and mastoid antrum (56 % vs. 80 %), hypointense-to-CSF signal intensity on T2 FSE (6 % vs. 86 %), intramastoid diffusion restriction (0 % vs. 62 %), intense intramastoid enhancement (0 % vs. 51 %), periosteal enhancement (3 % vs. 69 %), perimastoid dural enhancement 3 % vs. 43 %), bone destruction (0 % vs 49 %), intratemporal abscess or cholesteatoma (0 % vs. 24 %), labyrinth involvement (0 % vs. 14 %), and extracranial abscesses (0 % vs. 20 %). 2
39. Kucur C, Simsek E, Kuduban O, Celebi I, Gursel AO. The clinical value of temporal bone tomography in chronic otitis media. Kulak Burun Bogaz Ihtis Derg. 23(1):21-5, 2013 Jan-Feb. Observational-Dx 50 patients To investigate the indications, the results and the limits of preoperative computed tomography (CT) scanning in chronic otitis media (COM), and to evaluate the clinical contribution of CT in determining the nature and complications of the disease. Computed tomography was highly sensitive to the presence of soft tissue, mastoid pneumatization, dural height, and temporal bone destruction with nearly 100% sensitivity. Its contribution to detecting lateral canal fistulas, facial canal dehiscence, tegmen tympani erosion, and ossicular integrity was limited. 2
40. Hiraumi H, Yamamoto A, Yamamoto N, Sakamoto T, Ito J. Detection of the petrosquamosal sinus in chronic otitis media using high-resolution CT. Otolaryngol Head Neck Surg. 149(3):488-91, 2013 Sep. Observational-Dx 84 patients To evaluate the prevalence of the persistent petrosquamosal venous sinus in patients with chronic otitis media using a high-resolution CT scan. A petrosquamosal sinus was detected in 42 (45.7%), a higher frequency than in ears without chronic otitis media (10.3%). The diameter of the sinuses was <1.0 mm in 20 ears, 1.0 mm to 2.0 mm in 17 ears, and >2.0 mm in 5 ears. The petrosquamosal sinus was positioned inferior to the lowest part of the middle fossa in 10 ears. 2
41. Karatag O, Guclu O, Kosar S, Derekoy FS. Tegmen height: preoperative value of CT on preventing dural complications in chronic otitis media surgery. Clin Imaging. 38(3):246-8, 2014 May-Jun. Observational-Dx 50 patients To examine tegmen height in patients with iatrogenic dural exposure in chronic otitis media (COM) surgery. There was no statistically significant difference between opposite ears (P>.05). Significant difference was found in tegmen height between healthy and operated ears in unilateral COM patients (P=.001). 2
42. Lee YF, Wei PY, Chu CH, Liao WH, Shiao AS, Wang MC. A Retrospective Study to Identify the Relationship Between the Dimension of Osseous External Auditory Canal and Chronic Otitis Media. Ear Nose Throat J. 99(8):532-536, 2020 Sep. Observational-Dx 62 patients To review the high-resolution computed tomography (HRCT) images of the temporal bones of 62 patients with unilateral COM who underwent tympanoplasty from January 1, 2011, to December 31, 2013. No results stated in the abstract. 2
43. Ng JH, Zhang EZ, Soon SR, et al. Pre-operative high resolution computed tomography scans for cholesteatoma: has anything changed?. American Journal of Otolaryngology. 35(4):508-13, 2014 Jul-Aug. Observational-Dx 26 patients To assess the predictive value of pre-operative CT imaging in pediatric patients affected by cholesteatoma of the middle ear, comparing pre-operative CT findings to intra-operative features. Overall, 28 surgical procedures were evaluated. No statistically significant differences were encountered between CT images and intra-operatory findings regarding the selected parameters. 2
44. Plodpai Y, Jongthitinon T, Atchariyasathian V, Pitathawatchai P, Hirunpat S, Kirtsreesakul V. Middle ear status in cholesteatoma: Associations among preoperative computed tomography scans, audiological assessments, and intraoperative endoscopic findings. Am J Otolaryngol. 43(1):103198, 2022 Jan-Feb. Observational-Dx N/A To discuss the Middle ear status in cholesteatoma. No results stated in the abstract. 2
45. Stasolla A, Magliulo G, Cortese A, Roncacci A, Marini M. Preoperative imaging assessment of chronic otitis media: what does the otologist need to know?. [Review]. Radiol Med (Torino). 116(1):114-24, 2011 Feb. Review/Other-Dx N/A To review the role of computed tomography (CT) and magnetic resonance imaging (MRI) in managing chronic otitis media (COM), with special attention to the key information required by the otologist for effective preoperative planning. No results stated in the abstract 4
46. Kusak A, Rosiak O, Durko M, Grzelak P, Pietruszewska W. Diagnostic imaging in chronic otitis media: does CT and MRI fusion aid therapeutic decision making? - a pilot study. Otolaryngol Pol. 73(1):1-5, 2018 Oct 01. Review/Other-Dx 5 patients To determine whether  CT and MRI fusion aid therapeutic decision making. CT scans were analyzed to establish the extent of previous surgical interventions and anatomical landmarks preservation. In all cases, MRI results were suspicious of cholesteatoma recidivism. Four cases were confirmed in postoperative histopathological evaluation, there was one false positive case when intraoperatively scar tissue was identified, which was later confirmed as connective tissue upon histopathological evaluation. 4
47. Russo C, Di Lullo AM, Cantone E, et al. Combining Thin-Section Coronal and Axial Diffusion Weighted Imaging: Good Practice in Middle Ear Cholesteatoma Neuroimaging. Front Neurol 2021;12:606692. Observational-Dx 103 patients To critically revise the role of combined thin-section coronal fast spin-echo–based non-EPI DWI of the temporal bone and axial spin-echo echo-planar DWI for the detection of middle ear cholesteatoma (both in the setting of acquired and residual/recurrent disease), in order to improve clinical management and optimize surgical procedures No results stated in the abstract. 2
48. Wiesmueller M, Wuest W, May MS, et al. Comparison of Readout-Segmented Echo-Planar Imaging and Single-Shot TSE DWI for Cholesteatoma Diagnostics. AJNR Am J Neuroradiol. 42(7):1305-1312, 2021 07. Observational-Dx 35 patients To compare the diagnostic value of readout-segmented echo-planar DWI and single-shot TSE DWI for cholesteatoma diagnostics. Twenty-five cases of histologically confirmed cholesteatomas were included in the study group. Lesion conspicuity was higher and fewer artifacts were found when using TSE DWI (both P < .001). The overall subjective image quality, however, was better with readout-segmented DWI. For TSE DWI, the sensitivity for readers 1 and 2 was 92% (95% CI, 74%-99%) and 88% (95% CI, 69%-97%), respectively, while the specificity for both readers was 80% (95% CI, 28%-99%). For readout-segmented DWI, the sensitivity for readers 1 and 2 was 76% (95% CI, 55%-91%) and 68% (95% CI, 46%-85%), while the specificity for both readers was 60% (95% CI, 15%-95%). 2
49. Baba A, Kurihara S, Fukuda T, et al. Non-echoplanar diffusion weighed imaging and T1-weighted imaging for cholesteatoma mastoid extension. Auris, Nasus, Larynx. 48(5):846-851, 2021 Oct. Observational-Dx 59 patients To assess the efficacy of non-echoplanar diffusion-weighted imaging (non-EPI DWI) and T1-weighted imaging in the evaluation of mastoid extension in cholesteatomas of the middle ear. A total of 59 patients with middle ear cholesteatoma were evaluated. There were 37 M+ cases and 22 M- cases. High-signal intensity on non-EPI DWI exhibited a sensitivity of 0.89 and specificity of 0.82, whereas partial low-signal intensity on T1-weighted imaging exhibited a sensitivity of 0.84 and specificity of 0.91 for detecting mastoid involvement. Complete high-signal intensity on T1-weighted imaging exhibited a sensitivity of 0.73 and specificity of 0.89 for detecting non-involvement of the mastoid. The sensitivity (0.92) and specificity (0.96) of combined non-EPI DWI and T1-weighted imaging evaluation were higher than those of with non-EPI DWI or T1-weighted imaging alone. The interobserver agreement for the presence of high-signal intensity in the mastoid cavity on non-EPI DWI was very good at 0.82, that of a partial low-signal intensity area in the mastoid cavity lesions on T1-weighted imaging was good, at 0.76 and that of complete high-signal intensity in the mastoid cavity lesions on T1-weighted imaging was good, at 0.67. 2
50. Barath K, Huber AM, Stampfli P, Varga Z, Kollias S. Neuroradiology of cholesteatomas. [Review]. AJNR Am J Neuroradiol. 32(2):221-9, 2011 Feb. Review/Other-Dx N/A To review the relevant aspects of cholesteatomas with the emphasis on their diagnosis by using cross-sectional imaging. No results stated in the abstract. 4
51. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
52. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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