Otitis 4: Eksterna - Therapy Management

Therapy Management
Edema because canalise the circumferential wall, to hang on the wall canalise drugs often need to use a wick. That can be used to scroll the small screen, but now also available products specifically designed for this purpose generally are preferred, such as Pope Otowick. Aligator Forsep can be used to enter the ear wick which was first dribble with ear solution selected. There are several options for therapy bat ear otitis external diffuse. Ear drops are frequently used Cortisporin (polimiksin B, neomisin, hidrokortison), Coli-Mycin S (kolistin, neomisin, hidrokortison), Pyocidin (polimiksin B, hidrokortison), VoSol HC (nonaqueus-acetate acid 2%, hidrokortison), and Chloromycetin (kloramfenikol).
Systemic therapy is only considered in cases of weight; recommended to perform sensitivity checks bacteria. Required systemic antibiotics, especially if the suspected perikondritis or kondritis the ear cartilage. Otitis external diffuse may also arise from secondary acute otitis media or chronicles. In the case of such, treatment is aimed primarily at the middle ear.

Of the People with acute Otitis External Diffuse:
a. Search factors fuse and risk factors
1. Diabetes, imunosupresi, old age
2. Exposed to water, the humid climate
3. Wearing hearing aids
4. Trauma to the ear hole cleaned at the time, scratches, equipment used
5. Dermatosis
6. Atopic, allergic, dermatitis or irritant
7. Topical treatment for the previous otitis or otitis media external
8. Previous ear surgery, such as timpanostomi
9. Radiotherapy for ear

b. search weight symptoms appear
1. Aches or feels heavy at the ear (pinna or tragus) or jaw
2. Itch
3. Hearing loss
4. Ear discharge

c. search affect work, social life, day-to-day activities.

d. search how serious infection that occurred
Inflammation can indicate illness if there is some signs as follows:
1. Canal red ear, udem, narrow, not clear that the debris.
2. Hearing loss (conduction)
3. Discharge, serous, or purulent
4. Limfadenopati regional.
5. Fever

e. search on timpani membrane not perforation
A little difficult to see the adequate membrane on the timpani of otitis external. Therefore:
1. Perforation can be assumed that if someone:
a. Can feel if there is a drug that is in the ear.
b. Can remove the ear / nose exhale air when patients click.
c. Installed timpanostomi insertion after the lapse of 12 months ago and was not found estrous membrane closure and timpani.
2. Timpanometri, if available, can help to show that membrane timpani still intact.

Treatment:
1. prescription or recommend giving painkillers to eliminate the symptoms. Offer of painkillers (such as paracetamol or ibuprofen) to reduce the pain.
2. treatment inflammation:
a. prescription preparation for topical ear for seven (7) days. The recommended option; corticosteroid a combination of antibiotics with non-aminoglikosid topical, corticosteroid topical with aminoglikosid, or antibiotics alone.
b. If there is pressure in the ear hole, consider ear wick insertion
3. Provide assistance for the right to cure and the risk of infection.
4. If found treatment skin conditions such as eczema and Psoriasis.
5. Consider referral to a specialist to clean up (micro suction) and / or ear wick insertion if this is required for a heavy infection.
Recommendations diffuse management of acute otitis external is based on evidence-based recommendations from the American Academy of Otolaryngology ¬ - Foundation for Head and Neck surgery (American Academy of Otolaryngology et al, 2006).

When the therapy or treatment acute otitis external diffuse fails / does not work, then must be re-examined the following:
a. Review of diagnosis and the other conditions set
b. Review the treatment
1. Suggest to use ear drops or slap
2. Consider re-therapy, or replacement of the drug drops to spray the medicine.
c. Review whether factors that disrupt topical treatment that is used to treat this disease;
1. If there is discharge, consider irrigation (maintaining membrane remains intact timpani), or microsuction.
2. If there is great pressure in the ear hole, consider the insertion axis ear initials or systemic antibiotics.
d. If contact dermatitis due to neomycin or other aminoglikosid
1. Consider the replacement of medicine that does not contain aminoglikosid.
2. Experts to consider for the skin sensitivity test.
e. If there are any signs of systemic infection or infection spreads out the ear hole, recipes oral antibiotics for seven (7) days (such as flucloxacillin, or eritromycin if sensitive to penicillin, or if there claritromycin on the two drugs contraindication above)
f. If this treatment have been tried or can not be applied to the patient, the culture should be done in the ear hole of the specimens to identify the fungus and bacteria resistant. If you believe the possibility of infection with the fungus treat the preparation topical containing anti fungus ear drops such as clotrimazole 1% (Canesten ®), or flumetasone pialate 0.02% (Locorten-Vioform ®)
g. Last to recommend to the specialist.
This recommendation is pragmatic advice based and most of the opinions of experts (American Academy of Otolaryngology et al, 2006).