gramicidin-a and Otitis-Externa

Acute otitis externa is a common clinical condition accounting for a large proportion of patients attending the otolaryngology department, although milder cases are often managed in primary care. Treatment of the most severe forms of otitis externa involves aural toilet, followed by the application of a topical preparation, commonly in the form of an ear canal dressing. A prospective single-blind randomized controlled trial was performed to compare the efficacy of 10% glycerine-ichthammol (GI) solution and Triadcortyl (TAC) ointment, both applied as ear canal dressings, in the initial management of severe acute otitis externa. A total of 64 patients were studied. Both treatment modalities were proven efficacious in the treatment of severe acute otitis externa. Although there was a statistically significant improvement of pain parameters in the TAC group, we found no significant differences in clinical findings between the two groups. Therefore, it is recommended that GI dressing can be used instead of an antibiotic dressing as an initial treatment of severe acute otitis externa on the basis of cost, avoidance of resistance and toxicity.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Drug Combinations; Female; Glycerol; Gramicidin; Humans; Male; Middle Aged; Neomycin; Nystatin; Otitis Externa; Pain Measurement; Quaternary Ammonium Compounds; Solvents; Treatment Outcome; Triamcinolone Acetonide

Otitis externa and chronic otitis media often present to the otolaryngologist with a discharging ear. The conventional method of treatment is to perform regular aural toilet and insert medicated dressings into the external auditory canal. This treatment is either performed by trained nurses or medical staff, but in either case is time consuming. This study compares the efficacy of the above standard regimen with a novel treatment where a single aural toilet is carried out and medicated ointment instilled into the ear. Both regimens were evaluated at three weeks. Our results shows that there was no significant difference between the two treatment regimens with regard to the resolution of either of the conditions studied or the improvement in the symptom status of the patients. On the basis of this it would seem that a single aural toilet and instillation of medicated ointment is a valid treatment option, cuts down hospital attendance and could be performed in the community by general medical practitioners or trained practice nurses.

Topics: Administration, Topical; Chronic Disease; Drug Administration Schedule; Drug Combinations; Gramicidin; Humans; Neomycin; Nystatin; Ointments; Otitis; Otitis Externa; Otitis Media, Suppurative; Triamcinolone Acetonide

A double-blind, randomised clinical trial was conducted in Queensland general practices to evaluate the efficacy of oral doses of trimethoprim-sulfamethoxazole (cotrimoxazole) as an adjunct to Kenacomb ointment in the treatment of acute diffuse otitis externa.. One hundred and five patients with otitis externa agreed to enter the trial; 13 of these had bilateral otitis externa. Six symptoms and signs of otitis externa were rated on a scale of 1 (none) to 5 (severe) and then the scores were averaged to give an index of severity. Swabs from all infected ears were cultured and then the patients were treated with Kenacomb ointment. Patients were randomly assigned to take a five-day course of either oral cotrimoxazole or an oral placebo and were reassessed on Days 2-4 and Days 5-6 after presentation.. The mean duration (+/- standard deviation) of ear pain from the first visit for the cotrimoxazole and placebo groups was 3.1 (+/- 1.5) days and 3.1 (+/- 1.7) days respectively. The mean severity indices (+/- standard deviation) for these groups on presentation were 2.33 (+/- 0.59) and 2.37 (+/- 0.57). The respective reductions in these scores by the second visit were 0.72 and 0.69 and by the third visit 1.10 and 1.05. The principle pathogen isolated was Pseudomonas aeruginosa.. This suggests that oral cotrimoxazole is unlikely to be useful as an adjunct to Kenacomb ointment in the treatment of mild to moderate otitis externa.

Topics: Administration, Oral; Adult; Child; Double-Blind Method; Drug Combinations; Earache; Female; Gramicidin; Humans; Male; Neomycin; Nystatin; Otitis Externa; Placebos; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Tablets; Triamcinolone Acetonide; Trimethoprim, Sulfamethoxazole Drug Combination

In an open, multi-centre study in general practice, a comparison was made of the efficacy, tolerability and acceptability of a neomycin/dexamethasone preparation administered by metered-dose spray ('Otomize') and a framycetin/gramicidin/dexamethasone preparation ('Sofradex') administered as drops in 60 patients with otitis externa. Patients were allocated at random to receive one or other preparations 3-times daily for 10 days and were followed-up again 14 days after cessation of therapy. Clinical assessments were carried out under observer blind conditions on entry (Day 0) and on Days 10 and 24 of the severity of erythema, swelling and debris in the affected ear(s). A global assessment of clinical outcome was made by the doctor on Day 10. There were no significant differences in the two groups at the start of treatment. Significant improvement occurred in both groups from Day 0 to Day 10 and from Day 10 to Day 24 in all symptoms, with the proportion symptom-free in the 'Otomize' group significantly greater than in the 'Sofradex' group at 24 days, and approaching significance at 10 days. Significantly more patients in the 'Otomize' group were rated as having a good clinical outcome by the physician, and fewer patients experienced discomfort on application. Few side-effects were reported by either treatment group, none necessitating discontinuation of therapy.

Topics: Adolescent; Adult; Aerosols; Aged; Aged, 80 and over; Consumer Behavior; Dexamethasone; Drug Combinations; Family Practice; Female; Framycetin; Gramicidin; Humans; Male; Middle Aged; Multicenter Studies as Topic; Neomycin; Otitis Externa; Randomized Controlled Trials as Topic; Suspensions

In a randomized trial, 55 patients with acute external otitis were treated with either topical framycitin/gramicidin (Sofradex) or oxytetracycline/hydrocortisone (Terracortril) with polymyxin B (TPB) ear-drops for 1 week. Staphylococcus aureus and Pseudomonas pyocyanea were the bacteria most frequently found in the ear canal; 78% of the patients were cured. However, no significant differences in therapy were found when either of the preparations was used. S. aureus seemed to be most resistant to treatment, while P. pyocyanea was less of a therapeutic problem. Additionally, previous episodes of external otitis or other skin diseases did not seem to influence any treatment given.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Bacterial Infections; Child; Clinical Trials as Topic; Dexamethasone; Drug Combinations; Ear Canal; Female; Framycetin; Gramicidin; Humans; Hydrocortisone; Male; Middle Aged; Otitis Externa; Oxytetracycline; Polymyxin B; Polymyxins; Pseudomonas; Random Allocation; Staphylococcus aureus

To determine the expansile and absorptive properties of the expandable ear wick when tested with commonly prescribed ear drop preparations.. This in vitro study assessed wick expansion and absorption of drops when different ear drop preparations were applied. Nine commonly used ear drop preparations were tested (Gentisone HC, Sofradex, Otomize, Betnesol, Exocin, Canesten, Locorten-Vioform, EarCalm and ichthammol glycerin) with a standard expandable ear wick.. Weight, length and width of otowick following exposure to ear drops.. There was a marked difference in the absorption and expansion of the otowick when different drops were used. This corresponded to the aqueous or oil base of each preparation. All aqueous ear drop preparations (i.e. Gentisone HC, Sofradex, Otomize, Betnesol, Exocin and EarCalm) produced similar rates of absorption into, and expansion of, the otowick. The oil-based ear drop preparations (i.e. Canesten, Locorten-Vioform and ichthammol glycerin) failed to expand the wick and showed poor rates of absorption into the wick.. Expandable ear wicks should only be used in conjunction with aqueous ear drops. When using expandable otowicks as an adjunct to treating fungal otitis externa, acetic acid ear drops should be prescribed, as all other anti-fungal drops are oil-based.

Topics: Anti-Bacterial Agents; Dexamethasone; Drug Combinations; Ear Diseases; Equipment Design; Framycetin; Gentamicins; Gramicidin; Humans; Hydrocortisone; Instillation, Drug; Neomycin; Otitis Externa; Tampons, Surgical; Treatment Outcome

Patients receiving Gentisone HC, Sofradex and Otomize for chronic suppurative otitis media and otitis externa were investigated for compliance of medication. Drops were accurately weighed before and after use so that both the amount used and the expected amount patients should have used could be calculated. The amount used differed statistically from the amount expected for Sofradex (P = 0.0008) but not for Gentisone HC (P = 0.1049) or Otomize (P = 0.7553) when analysed by a Mann-Whitney U-test. There was a trend to overdose with both Sofradex & Gentisone HC. The reason for the differences, we believe, is due to a combination of both differing delivery systems and drop viscosities. Manufacturers need to improve delivery systems so that patients can deliver a reproducible volume of medication each time with ease.

Topics: Administration, Topical; Chronic Disease; Dexamethasone; Drug Combinations; Framycetin; Gentamicins; Gramicidin; Humans; Hydrocortisone; Neomycin; Otitis Externa; Otitis Media, Suppurative; Patient Compliance; Statistics, Nonparametric

Topics: Communicable Diseases; Drug Therapy; Ear Diseases; Gramicidin; Humans; Neomycin; Otitis Externa; Otitis Media; Triamcinolone Acetonide; Tyrothricin