Astringent preparations

A solution of acetic acid acts as an antifungal and antibacterial agent in the external ear canal. A proprietary preparation (EarCalm^® spray) is on sale to the public. It may be used to treat mild otitis externa but where there are more significant signs, treatment should include Aural Care (microsuction of the ear) and an anti-infective / anti-inflammatory ear drop.

Anti-inflammatory preparations

1. Prolonged use of topical corticosteroids should be used only following specialist advice.

2. Although mometasone is licensed for use on the scalp, this product is also used in the management of Chronic Otitis Externa. Patients are instructed to use one or two drops in the affected ear once daily. It may cause stinging as it is in an alcoholic solution.

Anti-infective preparations

1. Consideration should be given to the fact that pseudomonal resistance to aminoglycoside antibiotics is growing.

2. Ear swabs for culture should be reserved for treatment failures or chronic cases. They may be carried out using a urethral swab.

3. If infection is present a topical anti-infective agent that is not usually used systemically is indicated. It should be used for approximately one week only, to prevent fungal overgrowth or resistance.

4. The CSM have issued a reminder that treatment with a topical aminoglycoside antibiotic is contra-indicated in those with a tympanic perforation. The BNF advises that many specialists do use these drops cautiously in the presence of a perforation in patients with otitis media and where other measures have failed for otitis externa.

Anti-infective plus anti-inflammatory combination preparations

1. Sofradex^® is considered to be less suitable for prescribing as it contains two different aminoglycosides (see BNF). This is linked to growing pseudomonal resistance. Sofradex^® is reserved for use where other preparations are not effective.

2. Flumetasone 0.02%/clioquinol 1% (previously Locorten-Vioform^®, which is oil based, does not penetrate well when watery discharge is present (hence do not use in acute infection or acute on chronic infections).