Otitis Externa in Emergency Medicine Medication

  • Author: Samuel Lee, MD, MS; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Apr 20, 2010
 

Medication Summary

The agents used include analgesics for pain relief and acidifying solution to treat the infection. Otic antibiotic and steroid combinations have shown to be highly successful in treatment. Oral antibiotics in combination with otic antibiotic solutions have not shown to improve treatment success rates.[5]

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Analgesics

Class Summary

Otitis externa can be quite painful and patients frequently request analgesics. Inexpensive, simple nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation and irritation and can be paired with opiates to improve pain symptoms. In some cases, systemic analgesics are helpful before ear cleaning or wick placement.

Codeine/acetaminophen (Tylenol-3)

 

Indicated for treatment of mild to moderate pain.

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Acidifying agents

Class Summary

Inflammation and accumulated debris allow the growth of bacterial species. This growth is counteracted by the use of mild acidifying medications, such as acetic acid solutions (eg, VoSol).

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Acetic acid solution (VoSol)

 

Inexpensive agent; works well in treating superficial bacterial infections of otitis externa.

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Otic antibiotics

Class Summary

These agents are commonly prescribed for treating otitis externa and are associated with cure rates between 87% and 97%.[3]

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Dexamethasone/ciprofloxacin

 

Fluoroquinolone with activity against pseudomonads, streptococci, MRSA, Staphylococcus epidermidis, and most gram-negative organisms but not anaerobes. Inhibits bacterial DNA synthesis and, consequently, growth. Dexamethasone decreases external auditory canal swelling and relieves pain symptoms.

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Neomycin, polymyxin B, and hydrocortisone (Cortisporin Otic)

 

Antibacterial and anti-inflammatory solution for otic use. Treats superficial bacterial infections of external auditory canal.

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Ofloxacin otic

 

Pyridine carboxylic acid derivative with broad-spectrum bactericidal effect.

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Ciprofloxacin otic (Ciloxan, Cipro HC Otic)

 

Fluoroquinolone with activity against pseudomonads, streptococci, MRSA, Staphylococcus epidermidis, and most gram-negative organisms but not anaerobes. Inhibits bacterial DNA synthesis and, consequently, growth.

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Contributor Information and Disclosures
Author

Samuel Lee, MD, MS  Resident Physician, Department of Emergency Medicine, Wayne State University School of Medicine, Detroit Receiving Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD  Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital

Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerry Balentine, DO  Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St. Barnabas Hospital

Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Mark W Fourre, MD  Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Roland PS, Stroman DW. Microbiology of acute otitis externa. Laryngoscope. Jul 2002;112(7 Pt 1):1166-77. [Medline].

  2. Osguthorpe JD, Nielsen DR. Otitis externa: Review and clinical update. Am Fam Physician. Nov 1 2006;74(9):1510-6. [Medline].

  3. Wall GM, Stroman DW, Roland PS, Dohar J. Ciprofloxacin 0.3%/dexamethasone 0.1% sterile otic suspension for the topical treatment of ear infections: a review of the literature. Pediatr Infect Dis J. Feb 2009;28(2):141-4. [Medline].

  4. [Guideline] Rosenfeld RM, Brown L, Cannon CR, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. Apr 2006;134(4 Suppl):S4-23. [Medline]. [Full Text].

  5. Roland PS, Belcher BP, Bettis R, et al. A single topical agent is clinically equivalent to the combination of topical and oral antibiotic treatment for otitis externa. Am J Otolaryngol. Jul-Aug 2008;29(4):255-61. [Medline].

  6. Kim D, Bhimani M. Ramsay Hunt syndrome presenting as simple otitis externa. CJEM. May 2008;10(3):247-50. [Medline].

  7. Beers SL, Abramo TJ. Otitis externa review. Pediatr Emerg Care. Apr 2004;20(4):250-6. [Medline].

  8. Block SL. Otitis externa: providing relief while avoiding complications. J Fam Pract. Aug 2005;54(8):669-76. [Medline].

  9. Niparko JK. Hearing loss and associated problems. In: Principles of Ambulatory Medicine. 4th ed. Lippincott Williams & Wilkins; 1995:1408-9.

  10. Rahman A, Rizwan S, Waycaster C, Wall GM. Pooled analysis of two clinical trials comparing the clinical outcomes of topical ciprofloxacin/dexamethasone otic suspension and polymyxin B/neomycin/hydrocortisone otic suspension for the treatment of acute otitis externa in adults and children. Clin Ther. Sep 2007;29(9):1950-6. [Medline].

  11. Rosenfeld RM, Singer M, Wasserman JM, Stinnett SS. Systematic review of topical antimicrobial therapy for acute otitis externa. Otolaryngol Head Neck Surg. Apr 2006;134(4 Suppl):S24-48. [Medline].

 
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Otitis externa with ear wick in place. Note discharge from canal and swelling of canal.
 
 
 
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