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Assessment and management of chronic otitis externa

Kesser, Bradley W.

Current Opinion in Otolaryngology & Head and Neck Surgery: October 2011 - Volume 19 - Issue 5 - p 341–347
doi: 10.1097/MOO.0b013e328349a125
Otology and neuro-otology: Edited by Myles L. Pensak

Purpose of review Chronic otitis externa (COE) remains a frustrating problem for both patient and physician. The end stage of disease, medial fibrosing otitis externa, is very challenging to repair. New and old therapies and promising approaches to the treatment of this often recalcitrant problem are presented in this review.

Recent findings Tacrolimus, a nonsteroidal immunosuppressant, and fluocinolone acetonide oil 0.01%, a medium-high potency steroid preparation, may offer additional therapeutic options in the struggle against this inflammatory ear canal/skin condition of often unknown cause. Relative potencies of many steroid preparations will be presented along with several treatment strategies for controlling COE. Underlying autoimmune problems such as Sjögren's disease, sarcoidosis, and amyloidosis must be searched and, if present, addressed and treated for resolution of symptoms. Cutting edge therapies, including use of bacteriophages and inflammatory proteases, will also be reviewed.

Summary No single therapy will be successful for every patient with COE. The search for an underlying cause, the removal of all possible irritants to the ear canal skin (e.g. Q-tips, water), debridement, and both topical and occasionally, systemic therapy will control (not cure …) the disease process in the vast majority of patients.

Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Virginia, USA

Correspondence to Bradley W. Kesser, MD, Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Box 800713, Charlottesville, VA 22908, USATel: +1 434 924 2040; fax: +1 434 982 3965; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.