If local treatment is to be effective, the canal must be thoroughly cleaned after taking a swab for bacterial and fungal cultures.
In early cases, gentle cleaning of the canal with a cotton tipped probe will be effective.
It is pointless to instill ear drops into a canal filled with debris since, in order for topical therapy to be effective, the medication must be able to make direct contact with the underlying skin of the canal.
If the lumen of the canal has been narrowed by edematous skin, suction debridement under the microscope is preferred.
In these cases, the patient will be unable to instill a topical preparation into the occluded ear canal and a Pope Otowick is gently eased as far as possible into the canal, moistened and then impregnated with a suitable topical antibiotic and anti-inflammatory preparation.
This wick should be replaced on a daily basis until the swelling has subsided and the drops can be directly instilled into the canal.
In severe cases the oral administration of non steroidal anti-inflammatory preparations such as indomethacin may be of substantial value.
The most commonly prescribed topical ear drops contain an antibiotic effective against Pseudomonas, e.g. an aminoglycoside, together with a corticosteroid to reduce inflammation.
The inclusion of a local anesthetic in some preparations used for the treatment of acute diffuse otitis externa is not warranted, since reactive allergic dermatitis is a possibility, and if analgesia is required then systemic medication is preferred.
One must be extremely careful when prescribing any topical antibiotic drop that contains potentially ototoxic substances that the tympanic membrane is intact so that the ototoxic material cannot enter the middle ear and come into contact with the inner ear via the round window membrane or the oval window.
A selvedged ribbon gauze wick has been inserted into the patient's external auditory canal. The wick will help carry topical medication into the canal.