Abstract
Introduction: Otitis externa, characterized by general oedema and erythema of the external auditory canal, can be treated by various modalities including aural toilet, topical antibiotic agents, with or without corticosteroids. This prospective randomized study has been undertaken to compare the efficacy of ichthammol glycerin pack with steroid antibiotic pack as the initial treatment for acute otitis externa.
Materials and Methods: A prospective randomized study was carried out on 60 patients diagnosed with acute otitis externa. The patients were randomly divided into two groups. In group A, Ichthammol glycerin pack was kept and in group B, steroid antibiotic pack was inserted. In all the patients the tragal tenderness, VAS score and edema score at the time of presentation were compared with these scores at two days follow up.
Results: It was observed that there was statistically significant decrease in the mean pain score and the edema of the external auditory canal (p< 0.001) in both group A as well as group B. Even the tragal tenderness significantly improved within 48 hrs. in both groups (p<0.001). But there was no statistically significant difference in the efficacy of both the groups compared to each other.
Conclusion: In this study, both ichthammol glycerin as well as antibiotic steroid combination proved to be effective as the initial treatment of acute otitis externa. Still we would like to recommend ichthammol glycerin pack as initial treatment as it is more cost effective with no risk of antibiotic resistance and is safe in cases of immunocompromised patients.
References
- Carney AS. Otitis externa and otomycosis. In: Gleeson M(ed.), Scott Brown’s Otorhinolaryngoly: Head and Neck Surgery, Vol 3, 7th edition, Hodder Arnold: London. 2008 p. 3351.
- Bojrab DI, Bruderly T, Abdulrazzak Y. Otitis externa. Otolaryngol Clin North Am 1996;29:761-82.
- Carney AS. Otitis externa and otomycosis. In: Gleeson M(ed.), Scott Brown’s Otorhinolaryngoly: Head and Neck Surgery, Vol 3, 7th edition, Hodder Arnold: London. 2008 p. 3352.
- Russell JD, Donnelly M, McShane DP, et al. What causes acute otitis externa? J Laryngol Otol 1993;107:898-901.
- Hajjartabar M. Poor-quality water in swimming pools associated with a substantial risk of otitis externa due to Pseudomonas aeruginosa. Water Sci Technol 2004;50:63-7.
- Holten KB, Gick J. Management of the patient with otitis externa. Journal of Family Practice. 2001;50:353-60.
- Rosenfeld RM et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg 2006;134:S4-23.
- Ahmed k, Roberts ML, Manninon PT. Antimicrobial activity of glycerine-ichthamol in otitis externa. Clin Otolaryngol Allied Sci 1995;20:201-3.
- Nilssen E, Wormald PJ, Oliver S. Glycerol and ichthammol: medicinal solution or mythical potion? J Laryngol Otol. 1996;110:319-21.
- Rosenfeld RM, Singer M, Wasserman JM, et al. System review of topical antimicrobial therapy for acute otitis externa. Otolaryngol Head Neck Surg. 2006;134:S24-48.
- Jacobsson S, Karlsson G, Ringner P, Sanner E, Schrewelius C. Clinical efficacy of budesonide in the treatment of eczematous external otitis. Eur Arch Otorhinolaryngol. 1991;248:246-9.
- Emgard P, Hellstrom S. A group III steroid solution without antibiotic components: an effective cure for external otitis. J Laryngol Otol. 2005;119:342-7.
- Canon SJ, Grunwaldt E. Treatment of otitis externa with a topical steroid-antibiotic combination: a contolled clinical trial. Eye Ear Nose Throat Monthly 1967;46:1296-302.
- Shrestha BL, Shrestha I, Amatya RC, Dhakal A. Effective treatment of acute otitis externa: a comparison of steroid antibiotic versus 10% ichthammol glycerine pack. Indian J Otolaryngol Head Neck Surg. 2010;62:350-3.
- Hornigold R, Gillett D, Kiverniti E, Harries M. The management of otitis externa: a randomised controlled trial of a glycerol and icthammol ribbon gauze versus topical antibiotic and steroid drops. Eur Arch Otorhinolaryngol. 2008;265: 1199-203.
- Masood A, Moumoulidis I, Ray S, Chawla O, Panesar J. A randomised controlled trial comparing Triadcortyl with 10% glycerine ichthammol in the initial treatment of severe acute otitis externa. Eur Arch Otorhinolaryngol 2008;265:881-5
- Koch K. Managing otitis externa. S Afr Pharm J 2012;79:17-22.
- Gray RF, Sharma A, Vowler SL. Relative humidity of the external auditory canal in normal and abnormal ears, and its pathogenic effect. Clin Otolaryngol 2005;30:105-11.
- Ruckenstein MJ. Infections of the external ear. In: Cummings CW et al (eds) Otolaryngology head and neck surgery, 4th edn, vol 3. Elsevier Mosby, Philadelphia, pp 2979-87.
- Bhatta R, Pokharel R, Adhikari P, Neupane Y. A comparison of 10% ichthalmmol glycerine packs with steroid-antibiotic pack for relieving pain in cases of acute otitis externa. J Inst Med 2009;31:7-10.
- Neher A, Nagl M, Scholtz AW. Otitis externa: etiology, diagnostic and therapy. 2008;56:1067-79.
Corresponding Author
Dr Jasdeep Monga
Assistant Professor
SGT Medical College, Budhera, Gurugram
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.87
