Otitis externa

Question 1

Clinical features

Answer 1

Itching at first

Pain (mild to intense)

Fullness in ear canal

Scant discharge

Hearing loss

Pain on moving pinna

Question 2

Management

Answer 2

Obtain culture, esp. if resistant Pseudomonas sp. or s. aureus suspected, by using small ear swab.

Aural toilet

• The cornerstone of treatment.
• Dry mopping.

Syringing

• This is appropriate in some cases but the canal must be dried meticulously afterwards.
• For most cases it is not recommended.

Dressings

• After cleaning and drying,
• insert 10–20 cm of 4 mm Nufold gauze impregnated with a steroid and antibiotic cream.
• For severe OE a wick is important and will reduce the oedema and pain in 12–24 h.
• It needs replacement daily until the swelling has subsided.

Question 3

Topical antimicrobials

Answer 3

The most effective,

• esp. when the canal is open, is an antibacterial, antifungal and corticosteroid preparation e.g.

Ciproxin HC, 3 drops bd,

Kenacomb or

Sofradex drops or ointment, 2–3 drops tds or

Flumethasone 0.02% with clioquinol (locacorten–vioform) 1% 2–3 drops bd).

Question 4

Other measures

Answer 4

Strong analgesics are essential.

ABs have little place in treatment unless a spreading cellulitis has developed.

Prevent scratching and entry of water.

Question 5

Prevention:

Answer 5

keep ear dry

protect with cotton wool soaked with petroleum jelly.

Use an antiseptic drying agent (e.g. ethanol) after swimming and showering.

Question 6

Practice tip for severe ‘tropical ear’

Answer 6

Prednisolone (o) 15 mg statim then 10 mg 8 hrly for 6 doses followed by

Merocel ear wick

Topical Kenacomb, Ciproxin HC or Sofradex drops