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Otitis Externa/Swimmer's Ear
Published in Charles Theisler, Adjuvant Medical Care, 2023
Acetic Acid: Acidification of the ear canal with a topical solution of 2% acetic acid (VoSol) combined with hydrocortisone (VoSol HC Otic) for inflammation is an effective treatment in most cases.3 Acetic acid is known for its antimicrobial effect on bacteria. Acetic acid is present in vinegar in a 3%-5% concentration. Vinegar has been used in medicine for thousands of years.1, 4 To promote continuous contact, a soft cotton gauze plug (ear wick) can be inserted into the ear canal. The wick is then saturated with the acetic acid solution. Patients should keep the wick in for the first 24 hours and keep it moist by adding 3-5 drops of the solution every 4-6 hours. After 24 hours the wick can be removed, but the patient should continue to instill five drops of (2%) acetic acid otic solution three or four times daily thereafter for five to seven days or as long as needed. In pediatric patients, 3-4 drops may be sufficient due to the smaller capacity of the ear canal.1, 5
Myringoplasty
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Management of mucopurulent discharge from the ear would follow guidelines set by NICE,12 with first line being thorough microsuction to reduce the bacterial load followed by regular application of topical antibiotic preparation to the external ear canal. It is acceptable to use short courses of a topical antibiotic with or without corticosteroid, but careful consideration must be given to potential risk of aminoglycoside-induced ototoxicity in patients with a suspected or confirmed perforation.13 In such circumstances many ENT surgeons would use quinolone-based drops as they are not ototoxic.14 An ENT-UK position paper stated that a short course of topical aminoglycoside-based drops in the presence of a perforation was acceptable since pus in the middle ear associated with otitis media carries a higher risk of ototoxicity than the drops themselves. This course must be short and stopped as soon as the infection has cleared.15 An oral antibiotic may also be given in severe or unresponsive infections. An ear wick may be used for severe infections, but the duration of use of each wick should be kept to a minimum.
The importance of clinical history in suspected otosclerosis: a case report
Published in Hearing, Balance and Communication, 2018
Michele Tulli, Omar Gatti, Andrea Galli, Milena Ferraro, Davide Di Santo, Lucia Oriella Piccioni
The patient underwent an explorative tympanotomy that confirmed the presence of an isolated fracture of malleus handle and, verified the integrity and mobility of the remaining ossicular chain and noted scar tissue covered each free edges of the fracture without joining them together. After the debridement of the scar tissue that covered the free margins of the fracture, no necrosis was noted and absorbable gelatin sponge was placed in the tympanic cavity together with an Armstrong trans-tympanic drain (TTD) (Figure 2(A)). To minimize the movements of the tympanic membrane, we positioned absorbable gelatin sponge and an ear wick in the external auditory canal, maintained in place for 40 days. Six months after the intervention, the TTD had been expelled with good progressive recovery of the auditory deficit (Figure 2(B)) and without auditory fluctuation.