Results:During the study period, a total of 4305 cases of otitis externa were seen at TEREM. In the total sample, males and females comprised 50.8% and 49.2%, respectively (Fig. 1). The age distribution for this population and the strength of association with gender is shown in Figs. 2A and 2B.

OTITIS EXTERNA IN URGENT CARE IN ISRAELDr. Jay Wohlgelernter, Jenna Stoehr, Jeanine A Southerland, Dr Deena Zimmerman

TEREM Emergency Medical Centers, Jerusalem, Israel

BackgroundOtitis externa (OE) is a common diagnosis found in urgent care clinics. An inflammatory condition of the external ear canal, acute symptoms

may include redness, swelling, pain or sensitivity, with or without suppuration. It is often caused by bacterial infection1 and associated with

the warm and moist conditions that arise after recreational water activities, hence the colloquial term (swimmer’s ear).2 Despite its

prevalence in both acute and sub-acute urgent care, there is a sparse amount of published information on the epidemiology within the US 3-4,

and virtually no study that is specific to Israel. As the majority of reported cases do not require a hospital visit, community-based,

ambulatory urgent care clinics such as TEREM provide a unique, cross-sectional glimpse of OE prevalence in the population.

Conclusions:The results of this study provide preliminary, epidemiological data on the prevalence and treatment of otitis externa in Israel, the vast majority of which are handled within an ambulatory setting. The largest demographic group that presented with OE was children aged 0 – 10 years old. Diagnoses occurred variably across gender except within this age group with a significant association with males. OE was seen most seen during summer months, most likely due to increased water-related, recreational activities during these months. This data reflected similar trends to a multi-year study observing OE epidemiology in the United States.2

References:1. Roland PS, Stroman DW. "Microbiology of Acute Otitis Externa." The Laryngoscope 2002; 112: 1166–1177.2. Centers for Disease Control and Prevention. “Estimated Burden of Acute Otitis Externa – United States, 2003-2007.” MMRW 2011; 60: 605-609.3. Kaushik V, Malik T, Saeed SR. "Interventions for acute otitis externa." Cochrane Database of Systemic Reviews 2010.4. Rosenfeld RM, et al. "Clinical practice guide: Acute otitis externa." Otolaryngology - Head and Neck Surgery 2006; 134(4): S4-S23.

Study ObjectiveThe goal of this study was to report trends in the occurrence of otitis externa (OE) from patient data in an Israeli urgent care setting.

MethodsStudy Design: Retrospective chart review.

Study Setting: TEREM-Emergency Medical Centers is a network of 16 community-based urgent care centers with nation-wide distribution.

Population: All patients who visited any TEREM center during the 2015 calendar year with a discharge diagnosis of otitis externa.

Data collection: All clinical encounters are documented through a unique, physician-designed, electronic medical record (EMR) system and stored within a

computerized data warehouse. The data warehouse was queried for the inclusion criteria.

Data analysis: Descriptive statistical analysis.

49.2%50.8%

Otitis Externa Cases by Gender

Female Male

Figure 1. Distribution by gender in patient population that was seen by a physician for otitis externa.

20.0% 10.0% 0.0% 10.0% 20.0%

0-10Y

10-20Y

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Percent of Sample Population

Ag

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Otitis Externa by Gender and Age Group

Male Female

Figure 2. Distribution of gender for each age group in patient population that was seen by a physician for otitis externa. (A) The greatest proportion of the population 36.1% [± 1.43, 95% CI] was represented by age group less than 10. (B) There was significantly stronger association with gender in younger pediatric patients (patients less than 10) than in patients older than 10 [p<0.005, Fisher's exact test, two-tailed].

0%

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Otitis Externa by Gender, Ages <10Y

Female Male

A B

30.38%

28.59%

21.32%

19.70%

Percent Otitis Externa Cases by Season

Summer Fall Winter Spring

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309

247292 285 271 264

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Otitis Externa Cases by MonthA

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Figure 3. Otitis Cases by Month and Season. (A) The percent of total cases as reported by season. Summer (JUN-AUG), Fall (SEP-NOV), Winter (DEC-FEB) and Spring (MAR-MAY). (B) The greatest proportions of cases, 15.4% [± 1.08, 95% CI] and 12.2% [± 0.98, 95% CI], were seen in the months of August and September.

As expected, the greatest number of cases occurred in the summer months (30.4%), followed by autumn, with a steep decline in the winter and spring months (Figs 3A-B).

Only 8% of all patients seen were co-diagnosed with otitis media and less than 10% presented with elevated temperature (>37.5ºC).

Virtually all patients, (99.3%) were discharged home after receiving medical evaluation, while the negligible remainder were sent to the ER.