Considerations on acute otitis externa for its optimized treatment

Abstract

Introduction and objectivesTo evaluate the optimal treatment for diffuse acute otitis externa (DAOE) by means of a new staging system based on clinical and otoscopic findings. MethodsMonitoring of otitis cases diagnosed at our centre over the last 21 months (n=1026), taking into account those who returned for a second visit, either via the emergency room or with a prior appointment. Staging of otitis externa by degree of obstruction of the external auditory canal (EAC): under 25% (type I, n=174); between 25% and 75% (type II, n=277); over 75% (type III, n=359); total obstruction due to organized oedema (type IV, n=216). ResultsIn most cases at an advanced stage, the canal was cleared by aspiration and placement of gauze or cellulose sponges. Topical ear drops were chosen in more than 95% of cases in every group, but anti-inflammatory and systemic antibiotic agents were administered in significantly larger amounts to patients in stages III and IV. Stage IV showed a statistically significant increase in the percentage of second visits. These manoeuvres improved pain, fullness and otorrhea significantly faster in stages I and II. ConclusionsStaging of otitis allows comparisons of the level of involvement and treatment recommendations: aspiration is advisable in stages II, III, and IV; placement of a wick inside the canal is necessary in stages III and IV. Topical ear drops seem to be needed in every case and systemic antibiotics almost only in stage IV. Acidifying agents and topical glycerine vehicles access the canal better than aqueous solutions and would be the first choice in advanced cases.