External Otitis, Then and Now

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March 1  |  Blog, York ENT Blog  |   James Rejowski

The American Academy of Otolaryngology- Head and Neck Surgery published a monograph last month regarding the evidence based proper treatment of external otitis, or outer ear infections.  The goal was to promote increased recognition and proper treatment of this common disorder.  Almost one half billion dollars are spent each year in the treatment of such infections.  Among other things, the aim was to avoid the inappropriate use of oral antibiotics, which are prescribed from 20-40% of the time as treatment, and in most cases are unnecessary and ineffective.

External otitis, frequently called swimmer’s ear, is an acute inflammatory disorder of the outer ear.  It is more common in the summer months.  The illness is characterized by the rapid onset of ear pain and itching.  Ear fullness and jaw discomfort are frequently present.  The examination will demonstrate redness and swelling in the ear canal and tenderness of the adjacent cartilages.

The conclusions of the study were as follows:

1) Adequate pain relief should be delivered.

2) Systemic antibiotic treatments should be avoided unless there is infection beyond the ear, or the patient has serious underlying health issues.

3) Other sources of ear discharge and inflammation should be excluded.

4) An assessment of other factors that would influence management such as the presence of tubes or a tympanic membrane perforation should be performed.

5) Topical treatments with antimicrobials should be delivered.

6) The patient should be educated regarding the proper methods of delivering the drops into the ear, including placing a wick into the area to bring the medicines within the canal.

7) In the presence of a perforation of the eardrum or a tube, medicines that could damage the inner ear should be avoided.

8) The patient should be reassessed within 48-72 hours if there is no significant improvement.

This is an elegant and detailed study which will be of great benefit to clinicians treating patients with this disorder.

When I was a medical student, I received a Manual of Otolaryngology originally written by Dr. Stanton A. Friedberg, the Professor and Chairman of the Department of Otolaryngology and Bronchoesophagology at Presbyterian St. Luke’s Medical Center in Chicago.  It was first printed in 1955 and was revised by Dr. Friedberg and Dr. Jim Hutchinson in the 1970s.  It was a practical, carry in your lab coat pocket, type of guide that would be of value to students and junior house officers early in their careers.  Many of the recommendations present in the current review were detailed by Dr. Friedberg and Dr. Hutchinson in their monograph. I apologize for the tiny print.

Sometimes the more things change the more they stay the same.

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