Otitis Externa

Important: Therapy

Analgesia and localised heat (warm flannel)

Important: Therapy

A proprietary preparation containing acetic acid 2% (EarCalm® spray) is on sale to the public.

Or Betamethasone with neomycin eardrops

• Apply 2 - 3 drops 3 - 4 times a day

Important: Therapy

NICE has produced a useful Clinical Knowledge Summary on management of chronic otitis externa.

• P.aeruginosa is a common cause of chronic otitis externa. P.aeruginosa is never reported susceptible ("S") to ciprofloxacin, but can only be susceptible at increased dose ("I") or resistant ("R"). 

Important: Therapy

Duration: 5 days

Flucloxacillin PO 250 - 500 mg 4 times a day. 

or  Clarithromycin PO 250 - 500 mg twice daily

Clarithromycin should not be prescribed concurrently with ciclosporin, sirolimus and tacrolimus.

Notes:

If systemic antibiotics are thought to be required for treatment, or if there is cellulitis extending from the ear canal or the ear canal is occluded, seek advice from a specialist to exclude malignant otitis externa.  

Important: Therapy

Malignant (necrotizing) otitis externa usually develops in elderly diabetic patients or other immunocompromised individuals; in these cases the infection spreads to the soft tissue, cartilage, and bone of the temporal region and skull base. Patients with malignant otitis have severe pain and otorrhoea, and cranial nerve palsies may be present; on examination, there is granulation tissue in the floor of the ear canal.

Notes:

These patients should be referred promptly to ENT.