Supervisors
Professor Alastair Hay (lead), Dr Ashley Hammond,
Rationale
Acute otitis media (AOM) is a common, painful condition of childhood, often treated inappropriately with antibiotics.
Optical coherence tomography (OCT), considered the optical analogue of ultrasound imaging, uses a low-intensity light source to produce real-time structural images with micron-scale resolution. This technology is coupled with high-resolution digital otoscopy imaging in the OtoSightTM Middle Ear Scope. The novel OCT images produced by the reflected near-infrared light are analysed and can be used to objectively differentiate air from middle ear fluid, as well as characterize fluid properties due to scattering of the imaging signal from particulates in the fluid. Its use within this feasibility study has two purposes: (i) confirmation of the presence of middle ear fluid (and therefore the AOM diagnosis); and (ii) daily serial imaging to visualize and chronicle the natural history of middle ear fluid resolution in a primary care population of children with suspected AOM. The latter is of particular interest because it could help understand whether the mechanism by which anaesthetic/glycerol drops work is to reduce the quantity, and therefore pressure exerted by, middle ear fluid.
Serial daily microbiological evaluation also has two purposes: (i) recording the possible cause of the infection; and (ii) describing the quantitative natural history of upper respiratory tract microbiota in a primary care population of children with diagnosed AOM.
Aims & Objectives
The aim of this PhD is to establish the feasibility and acceptability of daily OCT-otoscopy and microbiology in children who have presented to primary care with suspected AOM. Specifically, the objectives are:
1. Systematically review the literature for evidence regarding the use if serial OCT and microbiology
2. Conduct a prospective cohort study to
2.1 To establish parental acceptability of the study design (consent rate)
2.2 To record child and parental acceptability of daily serial middle ear fluid measures (OCT-otoscopy) and microbiology (nasal swabs)
2.3 To explore the association between quantitative OCT image signal changes for any middle ear contents present and ear pain between presentation and symptom resolution
2.4 To explore quantitative changes in bacterial/viral load and ear pain between presentation and symptom resolution.
Methods
Using methods employed successfully in the past, we propose to assemble a cohort of children with AOM who have recently presented to primary care.
For the mixed methods study, recruitment and follow up will be according to the following steps:
1. GP/practice nurse requests parental permission to notify study centre of potentially eligible children (following face-to-face or ‘COVID secure’ telephone assessment)
2. Student contacts parent to confirm interest in, and eligibility for, the study
3. E-consent taken
4. Student visits parent/child (at place of parent’s choosing – usually the family home)
5. Student confirms consent and willingness of parent to receive daily visits
6. Student conducts bilateral OCT-otoscopy and takes nasal swab, and advises parent in the use of the daily symptom diary (validated, and as used in previous studies)
7. Student visits daily until symptom resolution (usually no more than eight days)
8. Student administers brief questionnaire investigating parental acceptability of study procedures.
How to apply for this project
This project will be based in Bristol Medical School - Population Health Sciences in the Faculty of Health Sciences at the University of Bristol.
If you have secured your own sponsorship or can self-fund this PhD please visit our information page here for further information on the department of Population Health Science and how to apply.
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