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Necrotising otitis externa is a severe ear infection for which there are no established diagnostic or treatment guidelines.
This study described 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).
A standardised case-definition of necrotising otitis externa is needed to optimise diagnosis, management and research.
Twelve accelerator mass spectrometry (AMS) radiocarbon dates from the shell-matrix site of Canímar Abajo (Matanzas, Cuba) are reported. Eleven were obtained directly from human bone collagen in burials and one was obtained from charcoal recovered from a burial context. The site stratigraphy presents two episodes of burial activity separated by a shell midden layer. The AMS dates fall into two compact clusters that correlate remarkably well with the stratigraphy. The older burial dates to between 1380–800 cal BC (2σ) and the younger one to between cal AD 360–950 (2σ). The AMS dates are compared to eight conventional 14C dates previously obtained on shell and charcoal. One of the conventional dates on charcoal (5480–5380 cal BC; 2σ) has been reported as the oldest 14C date in the Caribbean region; its context and reliability are clarified. The suite of AMS dates provides one of the most reliable chronometric dating of a cultural context during this timeframe in Cuba. The correlation of 14C and stratigraphy establishes a solid chronology for investigating the important economic and ritual features of Canímar Abajo.