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Otitis externa - Management
How should ear drops be administered?

  • If practical, have someone other than the patient administer the treatment.
  • If there is substantial exudate, remove this by gentle (atraumatic) dry swabbing using a cotton bud or twist of cotton wool.
  • Warm the drops up to body temperature by holding the bottle in hands or pocket for a few minutes — this prevents the dizziness that can occur if cold drops are administered.
  • To administer the ear drops to ensure optimal delivery throughout the external ear canal:
    • The person should lie down with the ear to be treated uppermost.
    • The ear canal should be filled with ear drops. Gently pulling and pushing the ear helps to let air out of, and liquid into, the ear canal.
    • The person should remain in this position for 3–5 minutes. A kitchen timer may be useful to get young children to cooperate.
    • If the person (e.g. a small child) cannot lie still long enough to allow absorption, a small cotton plug covered with petroleum jelly or moistened with the drops and placed at the external opening of the ear canal for about 5 minutes can be used to help retain the drops in the ear.
    • A small cotton swab placed at the tragus can be used to catch any leakage from the ear when sitting up.
    • The ear canal should be left open to dry.
Basis for recommendation
  • These are pragmatic recommendations largely based on expert opinion [Sander, 2001; American Academy of Otolaryngology et al, 2006].
  • The recommendation that ear drops be warmed up to body temperature is to prevent nystagmus, dizziness, and vertigo from the equivalent of a caloric stimulation test of the auditory nerve [Sander, 2001].
  • The recommendation that someone else administer the ear drops if practical is based on evidence that up to 60% of people self-administering ear drops do not do this adequately for the first 3 days of treatment [American Academy of Otolaryngology et al, 2006].

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