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.