(A207) Assessing the Clinical Management of Acute Otitis Externa: A Retrospective Review

Introduction: Acute otitis externa (AOE) or “swimmer’s ear” is a common condition characterized by inflammation of the external auditory canal. Despite its generally benign presentation, AOE is often misdiagnosed. This study seeks to evaluate the clinical management of AOE in order to characterize healthcare burden due to patient misdiagnosis and overtreatment.

Methods: A retrospective review of AOE patient medical records (n=226) was conducted at the Puerto Rico Medical Center (PRMC). Eligibility criteria was based on ICD-10 diagnosis between January 2018 to December 2022. Data on patient demographics, clinical presentation, and management strategies were analyzed.

Results: Preliminary findings indicate significant mismanagement of patients presenting with AOE. Specifically, an 89% misdiagnosis rate was found upon specialist evaluation at our quaternary care center. AOE misdiagnosis due to suspected acute mastoiditis (AM) alone accounted for approximately 63% of these redundant referrals. Radiologic-detected mastoid effusion was the primary reason cited for suspected AM. All misdiagnosed patients had completed unnecessary oral antibiotic regimens and CT-imaging.

Conclusions: This study highlights the importance of a careful and comprehensive evaluation of patients presenting with AOE in order to mitigate healthcare burden and costs associated with its misdiagnosis and mismanagement. The use of aural toileting, ototopical agents, and analgesics are the recommended first-line treatments for AOE upon diagnosis, whereas oral antibiotics and CT-imaging are contraindicated due to the increased risk of antibiotic resistance and damage to local radiosensitive organs. While mastoid effusion is a common radiologic finding among AOE patients, its clinical significance shouldn’t be over-interpreted barring additional definitive evidence of AM. Future work may address a more comprehensive diagnostic algorithm for primary care centers and emergency departments to enhance clinical decision-making.