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Page: Treatment
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The goal of treatment is to cure the infection and to return the ear canal skin to a healthy condition. When external otitis is very mild, in its initial stages, simply refraining from swimming or washing the hair for a few days, and keeping all implements out of the ear, usually results in cure. For this reason, external otitis is called a self-limiting condition. However, if the infection is moderate to severe, or if the climate is humid enough that the skin of the ear remains moist, spontaneous improvement may not occur.
The use of topical solutions and suspensions in the form of ear drops is the mainstay of treatment for external otitis. These drops both physically wash collected debris from shed skin and infected drainage from the ear canal, and contain substances that either kill pathogenic germs, stop them from multiplying, or do both. The drops generally contain drying substances (astringents), acidifying agents, antibiotics and/or anti-fungal agents. Some prescription drops also contain anti-inflammatory steroids. Although there is evidence that steroids are effective at reducing the length of treatment time required, fungal otitis may be aggravated by the use of topical steroids.
When the condition has progressed to the point where the ear canal is blocked, a physician may have to begin treatment by clearing the ear under otoscopic examination and placing a thin strip of an absorbent material (ear wick) into the ear canal. In severe cases of external otitis, an otologist is needed to carefully clean out the ear canal under microscopic visualization. In such severe cases, in which drainage is abundant enough to recurrently block the ear canal, a qualified health professional may aspirate the ear as many times as twice a week for the first two or three weeks of treatment. Do note that it is imperative that there is visualization of an intact tympanic membrane. Use of certain medications with a ruptured tympanic membrane can cause tinnitus, vertigo, dizziness and hearing loss in some cases.
Although the acute infection of external otitis generally resolves in a few days with topical washes and antibiotics, weeks are required before the ear canal skin is fully normal. The glands of the outer skin of the ear canal will not begin producing cerumen again until the skin is not only no longer infected, but no longer inflamed. Once healed completely, the ear canal is again self-cleaning. Until then, slight irritation can be enough to cause external otitis to flare again.
Effective medications include eardrops containing antibiotics to fight infection, and corticosteroids to reduce itching and inflammation. The first line is a topical preparation such as 2% acetic acid or a topical antibiotic solution containing antibiotics such as aminoglycoside, polymyxin or fluoroquinolone. It is possible to have both a bacterial and fungal ear infection, and many of the topical treatments are designed to cure both.
Ear drops used abundantly help in clearing out the shed skin and dead bacteria in the ear canal, as well as in directly fighting the infection by interfering with the growth of bacteria. If the ear canal is very swollen, a wick may be applied in the ear to allow the drops to travel to the end of the canal. Occasionally, pills may be used in addition to the topical medications. Analgesics may be used if pain is severe. Putting something warm against the ears may reduce pain.
Non-prescription remedies
Provided it is not too severe, recurrent otitis externa can often be successfully treated by non-prescription means, at low cost. When symptoms recur in an individual who has had a previous diagnosis made, the use of non-prescription drops along with precautions to keep water out of the ear is generally effective. Self-treatment with non-prescription remedies is dangerous in individuals who have not been previously evaluated for the condition, because the tympanic membrane may not be intact, and because the true condition may be otitis media with drainage. Drops and water precautions may actually resolve otitis media with drainage for a period of time, while allowing an undiagnosed cholesteatoma to progress, or complications of otitis media to develop.
Effective solutions for the ear canal include acicifying and drying agents, used either singly or in combination. When the ear canal skin is inflamed from the acute otitis externa, the use of dilute acetic acid may be painful.
Burow's solution is an effective remedy against both bacterial and fungal external otitis. This is a buffered mixture of aluminum sulfate and acetic acid, and is available without prescription in the United States.
Prevention
The stategies for preventing acute external otitis are similar to those for treatment.
* Dry the ear thoroughly after exposure to moisture. This can be accomplished by the use of drops containing dilute alcohol or Burow's solution. Alternatively, small battery-powered ear dryers, available at shops catering to watersports enthusiasts, may be used. The use of dilute alcohol drops is not recommended except for prevention, as the solution is painful if the skin is inflamed by an acute episode.
* Avoid swimming in polluted water.
* Avoid washing the hair or swimming if very mild symptoms of acute external otitis begin
* Although the use of earplugs when swimming and shampooing the hair may help prevent external otitis, there are important details in the use of plugs. Hard and poorly fitting ear plugs can scratch the ear canal skin and set off an episode. When earplugs are used during an acute episode, either disposable plugs are recommended, or used plugs must be cleaned and dried properly to avoid contaminating the healing ear canal with infected discharge. One simple method of fabricating soft waterproof disposable ear plugs is with cotton balls and petroleum jelly. These jelly coated cotton balls are NOT inserted into the ear canal, but pressed into the auricle to cover the opening of the canal.
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Important notice:
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other
qualified health provider with any questions you may have regarding a medical condition.
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