ear, nose, and throat disorders
External Otitis (Acute)
Treatment of Acute External Otitis
Debridement Topicalacetic acidand corticosteroids Sometimes topical antibiotics Inmild and moderate acute external otitis,topical antibiotics and corticosteroids are effective. First, the infected debris should be gently and thoroughly removed from the canal with suction or dry cotton swabs under adequate lighting. Water irrigation of the canal is contraindicated. Mild external otitis can be treated by altering the ear canal’s pH with 2%acetic acid(or white vinegar) and by relieving inflammation with topicalhydrocortisone; these are given as 5 drops 3 times a day for 7 days. Moderate external otitis requires the addition of an antibacterial solution or suspension, such asciprofloxacin,ofloxacin, orneomycin/polymyxin, (theneomycincomponent is highly sensitizing and allergy is common). When inflammation of the ear canal is relatively severe, an ear wick should be placed into the ear canal and wetted with Burow solution (5%aluminum acetate) or a topical antibiotic 4 times a day. The wick helps direct the drops deeper into the external canal when the canal is greatly swollen. The wick is left in place for 24 to 72 hours (or may fall out on its own), after which time the swelling may have receded enough to allow the instillation of drops directly into the canal. Severe external otitisor the presence of cellulitis extending beyond the ear canal may require systemic antibiotics, such ascephalexin500 mg orally 4 times a day for 10 days orciprofloxacin500 mg orally 2 times a day for 10 days. An analgesic, such as a nonsteroidal anti-inflammatory drug or even an oral opioid, may be necessary for the first 24 to 48 hours. Fungal external otitisrequires thorough cleaning of the ear canal and application of an antimycotic solution (eg,gentian violet, cresylate acetate,nystatin,clotrimazole, or even a combination ofacetic acidand isopropyl alcohol). However, these solutions should not be used if the tympanic membrane is perforated, because they can cause severe pain or damage to the inner ear. Repeated cleanings and treatments may be needed to fully eradicate the infection. Dry ear precautions (eg, wearing shower cap, avoiding swimming) are strongly advised for both external otitis and fungal external otitis. A blow dryer on a low setting can also be used to reduce the humidity and moisture in the canal. Afuruncle,if obviously pointing, should be incised and drained. Incision is of little value, however, if the patient is seen at an early stage. Topical antibiotics are ineffective; oral antistaphylococcal antibiotics should be given. Analgesics, such asoxycodonewithacetaminophen, may be necessary for pain relief. Dry heat can also lessen pain and hasten resolution. Applying a few drops of a 1:1 mixture of rubbing alcohol and white vinegar (as long as the eardrum is intact) immediately after swimming can help prevent swimmer's ear (and is also an excellent treatment for otomycosis). 