Otitis externa

Otitis externa often occurs in ears that are itchy due to eczema, seborrhoeic dermatitis or psoriasis, (due to scratching), or in those who swim and get water macerated ears. There may be pain and discharge, infected material must be removed.

Many cases of otitis externa recover after thorough cleansing of the external ear canal by suction and dry mopping.

Antibiotics may be given as drops; use a combination product with a steroid if it is difficult to differentiate between infection and inflammation.

These topical preparations should only be used short-term as prolonged use encourages fungal infections which are difficult to eradicate. Recurrent or persistent cases should be swabbed and treated according to sensitivities.

Eczema of the outer canal and pinna may need treatment with a steroid cream.

Betamethasone drops are good for non-infected eczematous otitis externa; betamethasone and neomycin can be used if it is infected.

Clioquinol and flumetasone (Locorten-Vioform^®) is used in fungal infections. It should not be used for longer than 10 days to prevent fungal overgrowth.

Clotrimazole 1% topical solution can also be used for fungal infections.

Sofradex^® and Otosporin^® are considered to be less suitable for prescribing as they contain two different antibiotics, one being an aminoglycoside. This is linked to growing pseudomonal resistance.