External Otitis

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1. Typical case:

    1. a child with ear’s pain

    2. a swimmer with ear’s pain

2. Approach

    1. at first check tympanic membrane

        1. intact: Dx ⇒ External Otitis

        2. perforated: refer the pt to the specialist

    2. if the canal is full of debris, try to clean it at first to take a look at the membrane

3. Treatment

    1. pH lowering agents:

        1. Otic drop Boric acid 2% 5drop qid

        2. or Otic drop acetic acid 2% 5drop qid

    2. Pain killer

        1. Susp ibuprofen 100mg/5cc, 5mg/kg or 1-2cc/kg/d qid

        2. Susp acetaminophen 120mg/5cc weight/2 cc qid

        3. Tab acetaminophen 500 mg qid

    3. Anti biotics

        1. Otic drop ciprofloxacin 3% 4 drops qid

        2. or Otic drop ofloxacin 3% 4drops qid

        3. or Cap ciprofloxacin 500 mg bid #10

            1. for DM pt, immunodeficient pt or severe disease

    4. Steroids

        1. otic drop dexamethasone 0.1% 4drops tds

        2. or Otic drop betamethasone 0.1% 4drops tds

    5. Steroids and Ciprofloxacin can be prescribed even in perforated membrane

        1. Otic drop Polymyxin-NH 4drops tds (neomycin, hydrocortisone, polymyxin B)

            1. do not use in perforated membrane

        2. Otic drop ciprosonate 4drops tds

    6. Anti fungal

        1. prescribe in refractory cases, immunodeficiency, DM

        2. Solution clotrimazole 1% bid

        3. or Cream ketoconazole 1% bid

4. A common prescription:

    1. Otic drop Boric acid 2% 5drops qid

    2. Susp acetaminophen 120mg/5cc w/2 qid

    3. Otic drop ciprofloxacin 3% 4drops qid

    4. Otic drop dexamethasone 0.1% 4drops tds