Otitis Externa

Features

• Painful erythema and edema of the ear canal skin.
• Diffuse inflammation of ear canal with crusts and discharge from ear.
• In diabetic or immunocompromised patients, osteomyelitis of the skull base ('malignant external otitis') may occur.

Management

• Protect the ear from additional moisture and avoid further mechanical injury by scratching.
• Clean ear with cotton wick.
• Dexatob 1 Dexcip ear drops 2 drops x TDS 'OR' Local dressing with Ichthhamolglycerine if there is swelling for 24-48 hours.
• when cellulitis of the periauricular tissue has developed—Tab- Novidat l Cipval (ciprofloxacin) 500mg PO x BD for 1 week (fluoroquinolones are effectiveness against Pseudomonas).
• Treatment of 'malignant external otitis' requires prolonged antipseudomonal antibiotic administration, often for several months.
• Novidatl Cipval (ciprofloxacin) 200-400mg IV x BD for 1 week then Tab- Novidati Cipval (ciprofloxacin) 500-1000mg PD x BD
• To avoid relapse, antibiotic therapy should be continued, even in the asymptomatic patient, until gallium scanning indicates marked reduction or resolution of the inflammation.
• Surgical debridement of infected bone is reserved for cases of deterioration despite medical therapy.