Management Of Otitis Externa Research Articles

Improving otitis externa management in secondary care through a standardised treatment algorithm.

Otitis externa is a common condition managed by junior doctor-led ENT clinics in secondary/tertiary care, but no national guidelines exist for presentations in these settings. The aim of this study was to implement a treatment algorithm to support junior doctors and improve otitis externa management. Baseline data were retrospectively collected for 16 weeks. A standardised otitis externa treatment algorithm was then implemented, and 16 weeks of data prospectively gathered. A second improvement cycle was completed thereafter focusing on topical antibiotics and water precaution advice. Overall, 202 cases of otitis externa managed between November 2021 to October 2022 were reviewed. Following the interventions, topical antibiotic prescribing improved (p = 0.01) as well as the provision of water precaution advice (p < 0.01). Junior doctors trended towards reviewing patients more frequently but required less senior support. Our treatment algorithm empowers junior doctors to become more independent in their management of otitis externa and improves overall otitis externa treatment.

To Determine the PH of External Auditory Canal in Otitis Externa: A Prospective Observational Study in a Tertiary Health Care Centre.

Otitis externa is an inflammatory condition of the external auditory canal which occurs due to any trauma, changes in the PH of the skin of external auditory canal. The normal PH of the external auditory canal skin should be in the acidic medium. This inhibits the growth of certain infectious microorganisms. Once the external canal skin PH becomes alkaline, the chances of inflammation of the skin increases. To assess the pH of the external auditory canal in cases of otitis externa with secretion and compare the treatment efficacy of treating it with topical anti-inflammatory like ichthammol glycerine, topical steroid cream and oral antibiotics. A prospective observational study involved a total of 120 patients who came with symptoms and signs of external otitis. pH of external canal was measured during first visit and at 42days. The patients were divided into three groups. First group was treated with Ichthammol glycerine, second group was treated with Ichthammol glycerine with topical steroid cream and third group was treated with oral antibiotics with topical steroid cream. Patients were analyzed based on severity score during first visit, at 7days, at 21days and 42days. This study involved 64(53.3%) patients were male and 56(46.7%) were females. The mean age group involved in the study was 42.50years. The mean PH value in the external auditory canal during the first visit was alkaline (6.09) and the mean PH value at 42days was changed to acidic (4.95) which was statistically significant (p = 0.00). There was significant reduction in the severity score in the oral antibiotic with topical steroid cream, followed by IG with topical steroid cream followed by Ichthammol glycerine (p = 0.001). In this study we have analyzed the pH level favorable in causing otitis externa and the best available treatment for the same. It has been observed that the alkaline Ph is more favorable in causing otitis externa. Efficacy of Topical corticosteroid with antibiotics is maximum in the management of otitis externa.

Incidence and Management of Acute Otitis Externa in a UK Centre Before and During the COVID-19 Pandemic

Objective: Patients with otitis externa (OE) are commonly referred to acute ENT services after failed treatment in community. This case series analyses the prevalence and management of OE in a UK ENT rapid access clinic (RAC) prior to and following the national lockdown imposed in March 2020. Materials and Methods: Retrospective case review of all patients referred with OE to the RAC between January 2019 and March 2021 with comparison of the cohorts before and after 1st March 2020. Data anaylsed included demographics, treatment methods, rates of admission, microbiological swab and CT results and rates of necrotising otitis externa (NOE). Results: There were 239 new referrals over the total study period. The rate of referral dropped from 12.1/month to 5.8/month following the March 2020 lockdown. There were no significant differences in rates of severe infection or NOE before and after the lockdown. The most common organisms grown were Pseudomonas aeruginosa, Candida, and Staphylococcus aureus. Conclusions: There was a considerable reduction in acute referrals for OE to this centre in the year following the March 2020 lockdown. There was no significant change in disease severity or management trends.

Otitis externa in a tertiary hospital in the South-South region of Nigeria: a three year review

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Certain climatic conditions tend to favor the development of some ear infections and inflammations especially of the external ear. Otitis externa connotes the inflammation of the external ear and tends to occur commonly. This study is aimed at determining the frequency of occurrence, the type of otitis externa and management of patients seen in an ear nose and throat clinic in Port Harcourt.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective review of all patients diagnosed with otitis externa within the period of January 2017 to December 2019. The diagnosis was mainly clinical. The clinic registers and patient’s case files were the source of data. Data sought included demographics, clinical features, forms and management of otitis externa. Patients with incomplete data were excluded. Data extracted were then analyzed using IBM statistical package for social sciences (SPSS) 25 version. Results were presented in scientific tables and figures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were a total number of 1296 of patients with otitis externa. Prevalence of otitis externa in the study was 28.77%. There were 54.2% females and 45.8% males with a ratio of 1.4:1. The age group 21-30 years was the age group most affected; n= 404 (31.2%). Chronic otitis externa was the commonest form seen; 74.8%. Unilateral affectation was commoner, seen in n=1073 (82.8%). Debris in the ear was found to be the commonest clinical feature followed by otalgia; 31.1% and 29.6% respectively. The treatment was mainly medical; comprising systemic and topical broad spectrum antibiotics, topical antifungal and steroidal drops, and aural toileting with wick dressing and analgesics. There were no major complications noted.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Otitis externa is common in the ORL clinic and the diagnosis is often based on history and physical examination. The chronic form is the commonest type encountered and treatment is mainly empirical.&lt;/p&gt;

AKT answer relating to management of otitis externa

AKT answer relating to management of otitis externa

AKT question relating to management of otitis externa

AKT question relating to management of otitis externa

Management of otitis externa with an led-illuminated gel: a randomized controlled clinical trial in dogs

BackgroundCanine otitis externa is a painful condition which can be challenging to treat due to difficulties in the administration of otic medication. This can be due to lack of owner compliance in the application of ear drops or due to the resentment that some dogs demonstrate when attempts are made to administer topical medication into a sensitive ear canal. The aim of the study was to assess the efficacy of a topical LED-illuminated gel (LIG) in canine otitis externa in comparison to standard of care therapy. Dogs with spontaneous otitis externa were randomly allocated in three groups: groups QW received LIG once weekly; BW received LIG twice weekly; group C received enrofloxacin and silver sulfadiazine twice daily. LIG consists of a topical application of a gel containing chromophores that, when illuminated by a LED lamp, re-emit fluorescent light which can stimulate physiological responses, promoting healing and controlling bacteria. The evaluation protocol (T0 to T5) considered clinical assessment (OTIS-3-index-scoring-system; pruritus-severity-scale; pain-severity-score; aural temperature), cytological scoring system, quali-quantitative bacteriologic assessment.ResultsAll groups (QW, n = 21; BW, n = 23; C, n = 20) showed improvement during the study (QW: P < 0.02 for cytological and pain scores, P < 0.003 for bacteriologic assessment, P < 10− 4 for pruritus, total OTIS-3 and temperature assessments; BW: P < 10− 4 for all clinical, cytological and bacteriologic assessments; C: P < 0.02 for all clinical and cytological assessments, P < 10− 4 for bacteriologic assessment). The highest clinical score reduction occurred in Group BW (P < 0.014 in T3; P < 0.001 in T4 and P < 10− 4 in T5). BW reached the clinically relevant effect level at T3 (− 3.26 ± 1.21 levels), QW reached it at T4 (− 3.24 ± 0.99), C did not reach it. No differences between groups were seen in the reduction of CFU/mL (T0-T5).ConclusionsAll treatment groups showed a positive clinical effect. LIG administered twice-a-week was the most favourable protocol of the study. LIG may be considered beneficial in the management of canine otitis externa; it seems to be effective in controlling the clinical condition, including the signs of inflammation and local pain, the bacterial growth, and it may help increasing treatment compliance.

Efficacy of medical grade manuka honey in acute otitis externa: A pilot study

Introduction: Manuka honey has been used in chronic diabetic ulcers and traumatic wounds. We have used Manuka honey in cases of otitis externa because of its antibacterial and anti-inflammatory properties. Objectives: The objective was to study the efficacy of topical applications of Manuka honey in the patients of acute otitis externa. Materials and Methods: Patients with acute otitis externa without any prior ear complaint or intervention were selected for the study after informed and written consent. All patients selected for the study were packed with Manuka honey-impregnated umbilical tape and pain scores; canal wall edema was recorded on days 0, 1, 3, and 7. Results: A total of 20 patients were included in our study. Twenty patients followed us on day 1, 15 patients on day 3, and seven patients followed us till day 7. The mean pain score for day 0 was 5.35, and the mean pain score decreased to 2.95 on day 1, and the difference was statistically significant. Conclusion: Manuka honey appears to be an effective therapeutic agent in the management of otitis externa.

Honey Potential as Topical Therapy of External Otitis

Otitis externa (OE) is an external microbial Meatus acousticus (MAE) infection due to damage to the normal MAE serumen skin coat that protects and maintains MAE moisture and temperature. Living in the warm and humid tropics, a decrease in skin pH due to activity in the water including swimming, and excess cerumen cleaning are predisposing factors for OE. The use of antibiotics locally concentrated in OE can not only attack pathogenic microbes but also have an impact on normal flora so that it has the potential to cause resistant microbes. Honey has anti-bacterial properties without the risk of resistance and has even been shown to modulate immunity and inflammation. Various invivo and invitro studies prove that honey has broad spectrum anti-bacterial activity. Honey is proven invitro to modulate immunity by affecting the release of various inflammatory cytokines. This shows that honey has the potential for OE therapy. This article aims to discuss the potential of honey as a topical OE therapy in the hope that it can be an alternative choice of therapy in the management of OE in humans that is safe, effective, and efficient.

Double Blinded, Randomized and Controlled Comparative Study Evaluating the Cleaning Activity of Two Ear Cleaners in Client-Owned Dogs with Spontaneous Otitis Externa

Ear cleaning is a therapeutic component in the management of otitis externa in dogs. The objectives of this study were to evaluate the in vivo efficacy and safety of a new ear cleanser, Sonotix® against EpiOtic® Advanced for the management of canine otitis externa. Eighteen clients owned dogs with a diagnosis of erythemato-ceruminous or purulent otitis externa were prospectively included and randomized to two treatment group: EpiOtic® Advanced and Sonotix®. Cytology and video-otoscopic examination (erythema, amount of cerumen and thickness and surface of ear canal covered by cerumen) of all affected ears were done at D0, both before (T0) and 30 minutes (T0 + 30 min) after ear cleaning. Then an ear medication was applied (Aurizon®, Vetoquinol). Owners were instructed to clean affected ears daily and apply the ear medication 30 minutes later for 5 days (D1-D5). Dogs were seen again at D6 for cytology and video-otoscopic examination. At T0, no significant differences were found between both ear cleansers groups regarding macroscopic and microscopic scorings. At T0 + 30 min and D6 cytological and video-otoscopic scores were significantly decreased (Wilcoxon test; p ® was statistically superior to Epiotic® as evidenced by the median global scores of video-otoscopic examination at T0 + 30 min (Mann Whitney Test, p ® seems to be more effective in removing cerumen than EpiOtic® Advanced.

Topical ear treatment - options, indications and limitations of current therapy.

Topical otic products form an integral part of the overall management of otitis externa. With an ever increasing array of ear drops and cleaners to choose from, appropriate selection of therapy can be difficult. The investigation of all cases of otitis externa should consider primary and secondary causes and predisposing and perpetuating factors. This article considers topical therapy under these same broad headings and discusses, through literature review, the various properties of the components of the ear cleaning solutions and drops.

Management of otitis externa and the veterinary nurse's role

Otitis externa represents a very large proportion of the cases in small animal practice. As practice clinics become increasingly busy veterinary nurses can be utilised to play an essential role in the management of these cases. This article is a brief overview of how to approach otitis externa to improve patient care, speed recovery and reduce the risk of re-occurrence, including the role veterinary nurses can play in the diagnosis and management of otitis externa. This article will discuss the importance of cytology, bacterial cultures, examination of the ear canal and ear cleaning/flushing.

The management of otitis externa in UK general practice

Acute otitis externa is common and provides a heavy workload for general practitioners. We aim to determine the first-line treatment used by general practitioners in the management of otitis externa and subsequent second-line treatment in a hospital ENT clinic. In addition, this study aims to ascertain whether local and national guidelines are being followed appropriately. A prospective observational study on the management of otitis externa in consecutive patients referred to an ENT emergency clinic was undertaken. Data were collected and analysed on symptoms, initial management by general practitioners, findings and treatment in the ENT clinic. A total of 106 patients were studied. The mean duration of symptoms before presentation to clinic was 13 days; 42% of patients received no treatment by their GP prior to referral to the ENT emergency clinic. Only 14% of patients received topical antibiotics alone, whilst 44% received oral antibiotics, either alone or in conjunction with topical antibiotics by their GP. Of the 106 patients, 86% received topical antibiotics in the ENT emergency clinic and oral antibiotics were reserved for those presenting with complicated acute otitis externa. Topical antibiotics are associated with a decrease in disease persistence, whilst oral antibiotics are associated with an increase. However, general practitioners are prescribing oral antibiotics more often than required. There are few regional guidelines and no explicit national guidelines on the management of acute otitis externa for GPs to refer to. We suggest the implementation of national guidelines to aid clinical practice.

The management of otitis externa: a randomised controlled trial of a glycerol and icthammol ribbon gauze versus topical antibiotic and steroid drops

We compared the use of glycerol and icthammol (G&I) ribbon gauze versus topical antibiotic and steroid drops in the management of otitis externa. Patients presenting with acute otitis externa were systematically recruited from attendance in the ENT emergency clinic. Exclusion criteria were age <18 years, diabetic patients, and those who had been previously treated for otitis externa by the department within the last month. A total of 43 patients were recruited with 48 infected ears, the mean patient age was 47 years, (range 18-80 years). Patients were randomised to either insertion of a G&I ribbon gauze or topical ear drops by means of a ballot with no stratification. All patients were reviewed 5 days later. Patients were asked to comment on their pain using the ten point visual analogue pain score. Oedema of the canal wall, presence of debris and visibility of the tympanic membrane were graded on microscopy. Patient satisfaction and return to work were assessed. There was a statistically significant decrease in the pain score between each visit for the entire group of patients and decrease in canal wall swelling (P < 0.001). There was no significant difference between drops and ribbon gauze in terms of pain relief, canal wall oedema, or aural discharge. Following microbiological analysis, 27.8% of bacteria were resistant to neomycin. The cost of treatment with G&I is less than a third of that for topical antibiotic-steroid drops and requires less patient compliance. Patient concerns with the ribbon gauze included its cosmetic appearance and loss of hearing and with drops included frequency of application. We recommend the use of G&I ribbon gauze as first-line treatment, particularly for those who have had allergies to carriers of drops, those that are poorly compliant or with poor manual dexterity, for example patients with rheumatic hands.

Primary Care Management of Otitis Externa

Otitis externa (OE) is an acute, painful inflammatory condition of the external auditory canal that affects all age groups and accounts for about half of all patients presenting with ear pain. Common causes are gram-negative bacteria, Staphylococcus aureus, fungi, and dermatologic conditions such as eczema, seborrhea, and psoriasis. Risk increases with prolonged exposure to heat and moisture, especially in those who swim frequently or live in a tropical climate. Treatment involves cleaning the canal thoroughly and instilling ototopical broad-spectrum antibiotics. Although OE is relatively benign and easy to treat in the primary care setting, it can have life-threatening complications, especially in diabetic and immunocompromised patients. This article reviews the differential diagnosis, outlines treatment, and discusses preventive measures. A patient-education sheet is provided.

Ear Disease and Its Management

Tissue changes, diseases or factors predisposing to, bacteria and yeast associated with, diagnosis of, and management of otitis externa, media, and interna are discussed in this article.

An audit of the management of acute otitis externa in an ENT casualty clinic

The management of acute otitis externa is variable, despite the fact that it is one of the commonest otological emergencies. We formed the impression that many patients attending our ENT casualty clinic with otitis externa were being treated and followed up inappropriately. To test this hypothesis we performed a retrospective pilot study on our practice which revealed a lack of uniformity in the management and follow-up of these patients. And as a result of this, guidelines were developed to improve our management of otitis externa and decrease the number of unnecessary review visits. Our practice was then audited prospectively over a six-month period with the guidelines in place. An improvement in the overall management and a rationalization of follow-up for otitis externa was seen by applying basic audit principles to this common clinical problem.

The general practice 'management of otitis externa'.

Clinical confusion, treatment failure and recurrence commonly plague the Management of Otitis Externa. The aim of this study was to investigate the clinical attitudes and habits of army general practitioners and to review the recent literature. The results of a questionnaire survey showed that although all the respondents agreed that aural toilet was important, only 50% felt confident in performing aural toilet and packing. There also appeared to be much greater scope for the use of astringents and effective preventative measures in addition to aural toilet. The discussion emphasises and need for careful selection of the most appropriate topical agent, whilst highlighting the roles of practical procedures, bacteriology and prevention. A practical guide to diagnosis and management is offered with the aid of illustrations and an algorithm.

A History of the Surgical Management of Otitis Externa in the Dog

A History of the Surgical Management of Otitis Externa in the Dog