Clinical features
Itching at first
Pain (mild to intense)
Fullness in ear canal
Scant discharge
Hearing loss
Pain on moving pinna
Management
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.
Topical antimicrobials
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).
Other measures
Strong analgesics are essential.
ABs have little place in treatment unless a spreading cellulitis has developed.
Prevent scratching and entry of water.
Prevention:
keep ear dry
protect with cotton wool soaked with petroleum jelly.
Use an antiseptic drying agent (e.g. ethanol) after swimming and showering.
Practice tip for severe ‘tropical ear’
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
