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306                                          THE EAR

Local treatment of the chronic stage requires the same meticulous toilet
of the meatus. Swelling of the meatal walls may be relieved by ribbon-
gauze wicks soaked in 10 per cent ichthammol glycerine. Irritation, causing
reinfection by scratching, is controlled by packing the meatus with a wick
impregnated with an antiseptic/cortisone cream. As the condition improves
the cream may be lightly applied to the meatal walls by a wool-tipped appli-
cator. Nocturnal itching may be relieved by sedatives, and scratching pre-
vented by a light gauze bandage over the affected ear or by wearing a pair
of clean cotton gloves.

Failure to respond to treatment may be caused by an underlying middle-
ear infection, sensitivity of the skin to the local application, usually an
antibiotic, or by secondary fungus infection.


Mycotic infection of the external auditory meatus is prevalent in tropical
and subtropical climates. The incidence in temperate climates has increased
in association with the use of topical antibiotics which leave a medium
sterilized of other organisms in which the fungus may flourish. The condi-
tion should be suspected when routine treatment fails to relieve a diffuse
otitis externa, where there is continued irritation in the ear and when the
mass of debris in the meatus rapidly re-forms after cleansing. The fungi
which are commonly found are Aspergillus niger and Candida albicans. In
aspergillus infections numerous black specks may be seen in the epithelial
debris. Microscopic examination of a smear from the debris will confirm
the diagnosis.

TREATMENT. Treatment consists in thorough cleansing of the meatus by
dry mopping and the application of nystatin either in powder or ointment
form. Amphotericin B (Fungilin) is also effective in Candida infections.
Alternatively, drops of 2 per cent salicylic acid in alcohol, or a ribbon-gauze
wick soaked in this solution, may be applied to the external meatus. Regular
attendance for treatment lasting 3 or 4 weeks is necessary for elimination of
the infection.


Seborrhoeic dermatitis, commonly referred to as scurf or dandruff, is charac-
terized by a scaly state of the scalp with patches of erythema, visible at the
hair margins and the postauricular sulcus, spreading below the lobe to
adjacent areas of the face. A diffuse otitis externa frequently results, with
secondary infection induced by scratching (Plate IX, 1).

TREATMENT. The scalp condition should be controlled by regular shampoos,
initially twice weekly, containing selenium sulphide (Selsun) or cetrimide
B.P. The meatus should be kept clean. An ointment containing salicyclic
acid, precipitated sulphur (each 600 mg) and petroleum jelly (30 g) may be
applied to the meatal skin with a wool-tipped applicator to prevent further
scaliness and formation of fissures at the introitus.


Seborrhoeic eczema, occurring as the result of skin sensitivity, may be
infective in origin or due to contact of the skin with an external substance,