INTRODUCTION
Otitis externa is a diffuse inflammatory condition of the external
auditory canal. (1) It can be divided into sub-categories including
acute (less than six weeks), recurrent acute, and chronic. Otitis
externa that lasts more than three months, or more than four attacks of
otitis externa per year, are defined as chronic otitis externa (COE).
(2) The majority of acute cases (98%) are bacterial infections, withPseudomonas aeruginosa (38%), Staphylococcus epidermis(9%), and Staphylococcus aureus (8%) being the most prevalent
pathogens (1). Fungal infection is less common, with increased
prevalence in chronic otitis externa resistant to topical antibacterial
treatment, and is often referred to secondary care. (3) Most cases are
mild and can be managed with topical antibiotics in primary care. (4)
Nevertheless, a significant proportion of patients still require input
by ear, nose and throat (ENT) specialists as the inflammation can
persist for weeks or even months despite intensive treatment. (5)
Patients with COE often require repeated visits to General Practice (GP)
and ENT clinics for treatment monitoring and microsuction (4,6,7). The
costs and healthcare burden are substantial (2,4), with resolution in
these cases challenging. At a certain point, clinicians will often have
used a majority of conventional treatments without resolution of the
infection. (4,7)
Prescription of a topical corticosteroid without antibiotic has been
advised for chronic and recurrent cases. (1,8,9) No specific topical
corticosteroid preparation has been advised in clinical guidelines, and
the senior author of this paper (CC) has been utilising fluticasone
propionate (Flixonase®). Fluticasone propionate drops
were used based on anecdotal evidence from peers, its high topical
activity (10) and its low risk of systemic effects. (11)
This article hence presents our experience of using fluticasone
propionate drops in managing patients with COE, referred to the ENT
department of a tertiary centre.