Therapeutic targets
- Improvement of the symptomatology
- Elimination of pathogens
Therapy recommendations
Symptomatic therapy for otitis externa:
- Cleaning of detritus (“decay products”) and cerumen (earwax) – Cleaning of the external auditory canal with H2O2 solution (3%) and daily strip insertion with ointment (e.g., aureomycin ointment) or solutions containing cortisone or ciprofloxacin.
- After decongestion of the auditory canal → abandon strips and switch to antibiotic-containing solutions (if necessary, in combination with locally, i.e. topically applied steroids).
- Analgesia (pain relief):
- Local anesthetics (lidocaine, procaine, or tetracaine).
- Analgesics/painkillers or anti-inflammatories/anti-inflammatory drugs (ibuprofen, acetylsalicylic acid (ASA), paracetamol, etc.) [is more effective]Attention! Acetylsalicylic acid (ASA) must not be used under any circumstances in children and adolescents, as there is a risk of so-called Reye’s syndrome. This disease is associated with brain and liver damage and is life-threatening for the affected children.
Specific therapy recommendations
- Otitis externa diffusa
- Irrigation of the ear canal with 1% gentian violet solution or see below systematic therapy (above).
- In case of bacterial colonization antibiotic ointments / drops according to antibiogram: ciprofloxacin, chloramphenicol, neomycin, polymyxin-B, bacitracin.
- In mycotic colonization (otomycosis: whitish / black fungal lawns) antifungal ointments / creams according to the results of microbiology (eg clotrimazole).
- In the dry form: Triamcinolone tincture (glucocorticoids).
- In lymphadenopathy (lymph node enlargement) and complicated course systemic antibiosis (antibiotic therapy): piperacillin + tazobactam (penicillin + ß-lactamase inhibitor); ceftazidime or cefepime* (cephalosporins); duration of therapy: 7 d.
- Rhagades etch with Argentum nitricum (5%).
- Otitis externa circumscripta
- Alcohol strip insertion, later alcohol and cortisone strip insertion.
- Systemic antibiosis (antibiotic therapy) in severe symptoms after antibiogram (determination of pathogen and resistance) with e.g. flucloxacillin (staphylococcal penicillins) or cefachlor or cefuroxime axetil (cephalosporins).
- Otitis externa maligna
- Ear canal cleaning with local antibiotics (ciprofloxacin ear drops).
- Systemic antibiosis against Pseudomonas aeruginosa; duration of therapy: min. 6 weeks; up to 6 months.
- 1st choice:ciprofloxacin (3 × 400 mg, i.v. or 2 × 750 mg, p.o.).
- 2nd choice:piperacillin (3 × 4 g, i.v.) ± aminoglycoside antibiotic.
- 3rd choice: Meropenem (3 × 1 g, i.v.) ± aminoglycoside antibiotic.
- Weekly swabs required for timely detection of pathogen resistance to the applied antibiotic.
- If persistence of inflammation is given if surgical sanitation indicated.
- Note: In persistence also always think of the differential diagnosis of a carcinoma of the auditory canal!
- Chronic otitis externa (causes: Diabetes mellitus, seborrheic dermatitis; chronic otitis media; sensitization to detergents).
- Ear canal care (blow-drying after showering or bathing; blow-drying thereby in the direction of the auricle pulled backwards, upwards).
- Regulation of the pH of the ear canal skin: 0.5-0.7 percent acetic acid ear drops.
- If necessary, insertion of topical steroids.
- See also under “Further therapy”.
* Caveat: With cefepime and creatinine clearance < 50 ml/min, there is a risk of encephalopathy (collective term for abnormal brain changes) with impaired consciousness, confusion, hallucinations, stupor (state of extreme mental and motor numbness), and coma; also myoclonus (brief involuntary twitching of single muscles or muscle groups) and seizures (incl. nonconvulsive status epilepticus/prolonged epileptic seizure) are possible.
Supplements (dietary supplements; vital substances)
Appropriate dietary supplements for natural defense should contain the following vital substances:
- Vitamins (A, C, E, D3, B1, B2 B3, B5, B6, B12, folic acid, biotin).
- Trace elements (chromium, iron, copper, manganese, molybdenum, selenium, zinc).
- Omega-3 fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)).
- Secondary plant compounds (eg beta-carotene, flavonoids, lycopene, polyphenols).
- Probiotics
Note: The listed vital substances are not a substitute for drug therapy. Dietary supplements are intended to supplement the general diet in the particular life situation.
