Introduction
With severe otitis externa, it seems strange the absence of fever. A new examination of body temperature is necessary, especially if the child complains of pain. It is adequate if doctors pay attention to the fact that it is impossible to drip medicine into the ear canal. Edema is so severe that it cannot help but increase the temperature of the child’s body (Wiegand et al., 2019).
Discussion
The patient care plan includes the debridement of the external auditory canal. Topical antibiotics (Ciprofloxacin and dexamethasone drops) and corticosteroids can be effective. With sufficient illumination, using suction or dry cotton swabs, it is necessary to gently remove infected decay products from the ear canal. Washing the ear canal with water is contraindicated; for mild otitis externa, therapy consists of changing the pH of the ear canal skin surface with 2% acetic acid (or white vinegar). Doctors can reduce inflammation with topical corticosteroids (hydrocortisone); five drops are prescribed three times a day for seven days.
If instilling medication is not possible due to extensive edema, and the patient was diagnosed with limited otitis, it is recommended to undergo a tympanostomy procedure. Providing the outflow of fluid and air exchange in the middle ear cavity, drainage prevents the development of inflammation and the accumulation of fluid in the tympanic cavity, which, when thickened, forms a syrupy secret (Hoberman et al., 2021). The procedure involves the insertion of a drain or a thin tube made of plastic (such as silicone). The drain diameter is tiny; it is about 0.5-1.2 mm. The operation is usually performed under general anesthesia and does not last more than 10 minutes.
If drainage is not possible and the patient is diagnosed with diffuse otitis media, it is necessary to provide general treatment to relieve inflammation. The patient’s condition is then assessed as severe or moderately severe, and antibiotics are mandatory. Cefuroxime 250 mg, one pill two times a day at intervals of 12 hours, is needed, as well as ibuprofen 200 mg two or three times a day for anti-inflammatory and analgesic purposes.
Conclusion
There is an option with the hormonal treatment of otitis and inflammation; however, due to the patient’s age, it should be abandoned, and other methods should be used, such as multivitamin preparations. The ear must be washed with hydrogen peroxide or nitrofural. The ear must not be wetted, and the patient must be prohibited from using headphones and hearing aids.
References
Hoberman, A., Preciado, D., Paradise, J. L., Chi, D. H., Haralam, M., Block, S. L., Kearney, D. H., Bhatnagar, S., Muñiz Pujalt, G. B., Shope, T. R., Martin, J. M., Felten, D. E., Kurs-Lasky, M., Liu, H., Yahner, K., Jeong, J. H., Cohen, N. L., Czervionke, B., Nagg, J. P.,… Shaikh, N. (2021). Tympanostomy tubes or medical management for recurrent acute otitis media. New England Journal of Medicine, 384(19), 1789–1799. Web.
Wiegand, S., Berner, R., Schneider, A., Lundershausen, E., & Dietz, A. (2019). Otitis externa: Investigation and evidence-based treatment. Deutsches Ärzteblatt International, 116(13). Web.