Objective Evidence for necrotising otitis externa (NOE) diagnosis and management is limited, and outcome reporting is heterogeneous. International best practice guidelines were used to develop consensus diagnostic criteria and a core outcome set (COS).Methods The study was pre-registered on the Core Outcome Measures in Effectiveness Trials (COMET) database. Systematic literature review identified candidate items. Patient-centred items were identified via a qualitative study. Items and their definitions were refined by multidisciplinary stakeholders in a two-round Delphi exercise and subsequent consensus meeting.Results The final COS incorporates 36 items within 12 themes: Signs and symptoms; Pain; Advanced Disease Indicators; Complications; Survival; Antibiotic regimes and side effects; Patient comorbidities; Non-antibiotic treatments; Patient compliance; Duration and cessation of treatment; Relapse and readmission; Multidisciplinary team management. Consensus diagnostic criteria include 12 items within 6 themes: Signs and symptoms (oedema, otorrhoea, granulation); Pain (otalgia, nocturnal otalgia); Investigations (microbiology [does not have to be positive], histology [malignancy excluded], positive CT and MRI); Persistent symptoms despite local and/or systemic treatment for at least two weeks; At least one risk factor for impaired immune response; Indicators of advanced disease (not obligatory but mut be reported when present at diagnosis). Stakeholders were unanimous that there is no role for secondary, graded, or optional diagnostic items. The consensus meeting identified themes for future research.Results The final COS incorporates 36 items within 12 themes: Signs and symptoms; Pain; Advanced Disease Indicators; Complications; Survival; Antibiotic regimes and side effects; Patient comorbidities; Non-antibiotic treatments; Patient compliance; Duration and cessation of treatment; Relapse and readmission; Multidisciplinary team management. Consensus diagnostic criteria include 12 items within 6 themes: Signs and symptoms (oedema, otorrhoea, granulation); Pain (otalgia, nocturnal otalgia); Investigations (microbiology [does not have to be positive], histology [malignancy excluded], positive CT and MRI); Persistent symptoms despite local and/or systemic treatment for at least two weeks; At least one risk factor for impaired immune response; Indicators of advanced disease (not obligatory but mut be reported when present at diagnosis). Stakeholders were unanimous that there is no role for secondary, graded, or optional diagnostic items. The consensus meeting identified themes for future research.Conclusion The adoption of consensus-defined diagnostic criteria and COS facilitates standardised research reporting and robust data synthesis. Inclusion of patient and professional perspectives ensures best practice stakeholder engagement.

Objective: Operation notes are important for care in surgical patients. The objectives of this study were to analyze the emergency general surgery (EGS) operation note documentation in accordance with the Royal College of Surgeons of England (RCSEng) guidelines and to assess the impact of creating awareness of the guidelines and effect of a new proforma. Material and Methods: A retrospective review of 50 EGS operation notes was conducted between December 2019 and March 2020 and compared to RCSEng guidelines. Education was delivered on the importance of documentation in accordance with RCSEng guidelines. A new electronic proforma was introduced. A further 50 EGS operation notes were analysed between August 2020 and December 2020. Results: One hundred operation notes were reviewed, and each given a score out of 19. Our interventions showed significant improvement to the average score (15.64 vs 17.96; p< 0.001). Within the second cycle, there was a statistically significance difference when comparing electronic to handwritten notes (18.55 vs 17.50; p= 0.001). Conclusion: Implementation of the new proforma showed improvement in operation note documentation when compared to the RCSEng standard. Therefore, this study emphasizes the need for surgeons to familiarize themselves with the current guidelines.

ObjectiveENT is underrepresented in the curriculum, and this has been compounded by coronavirus disease 2019. Recent restructures have removed ENT placements from the curriculum. This lack of exposure needs to be addressed, and increased use of online learning represents an opportunity to facilitate this. This study aimed to evaluate whether online learning can effectively deliver undergraduate ENT teaching. MethodsAn online ENT module was created; content was structured on the Sheffield Medical School curriculum. Pre- and post-module tests and 5-point Likert scales were used to assess student knowledge and confidence, respectively. ResultsA total of 115 participants were recruited. Test scores improved by 29 per cent (p < 0.001) and confidence by 66 per cent. Anatomy and ENT conditions demonstrated significant improvement in confidence, with a lower confidence score for examination. ConclusionThis study showed improved knowledge and confidence, whilst highlighting greater efficacy in content over practical skills teaching. Online learning is a validated educational tool; however, it should not be used as a replacement but as an adjunct to supplement learning.

Introduction: Necrotising otitis externa (NOE) is a serious, progressiveinfection of the external ear canal. If untreated, it can invade intotemporal bone, skull-base and surrounding tissue resulting in cranialnerve palsies, neurological infections and death. Patients present withunremitting, severe otalgia, otorrhoea and oedematous ear canalscontaining granulation. Surgery has a limited role; the mainstay oftreatment involves a long course of intravenous antibiotics. Currently,there is no data on the complications of antibiotic treatment for NOE.This project aims to provide evidence on the nature/frequency of severetreatment-related complications requiring a change in antibiotic regime.Methods: A retrospective 5-year cohort analysis was performed on 64patients who were treated for confirmed NOE with intravenous antibiotictherapy. Clinical notes, blood results and antibiotic prescriptions weredocumented and analysed. Results: Average duration of treatment was 11weeks (range=38 weeks). There was an average of 2.1 antibiotic regimesper patient with 10 cases requiring inpatient admission due totreatment-related complications. 63% of treatment changes were directlyrelated to adverse effects of intravenous antibiotics. Drugallergy/intolerance (n=18) and clinical deterioration i.e. Lack ofsymptomatic improvement and/or worsening inflammatory markers (n=18),were the most common reasons for antibiotic change. Neutropenia,deranged liver function tests and acute kidney injury were alsorecognised adverse effects of treatment. Conclusion: This study providesthe first evidence on the notable frequency of antibiotic-relatedcomplications in NOE patients. Larger, multicentre studies are requiredin the future to validate our findings and will better inform bothclinicians and patients of the risks of treatment.

A woman in her 70s with previous microemboli was under investigation for bilateral lower limb pain. A CT angiogram was ordered to identify a source and revealed dissection of the ascending thoracic aorta ([figure 1][1]). There was localised dissection extending from the aortic root up to the mid-