INFLAMMATION OF THE EXTERNAL ACOUSTIC MEATUS 307
such as cosmetics, jewellery or hair lotions and hair lacquer, but more
commonly to the topical use of antibiotics. The typical appearance is of
vesication followed by a serous exudate and accompanied by severe irrita-
tion. Scratching is likely to introduce secondary infection in those cases of
contact origin (Fig. 166).
Fig. 166. Seborrhoeic dermatitis and otitis externa. A, Non-infecth e (contact) dermatitis showing
vesiculation and weeping; B, After treatment with aluminium acetate dressings followed by beta-
TREATMENT. In infected allergic skin conditions the use of anti-inflammatory,
anti-allergic steroids combined with antibacterial agents is advised. A cream
containing triamcinolone (Adcortyl) or fluocinolone acetonide (Synalar)
should be applied.
In eczematous types of otitis externa resistant to treatment an underlying
psychological disturbance may be present. Intense itching is the main symp-
tom causing considerable distress to the patient with loss of sleep. Secondary
infection usually produces a diffuse reaction. A disturbed mental state may
be apparent or careful enquiry may reveal a state of stress.
TREATMENT. Local measures are directed at the relief of secondary infection
and the control of irritation with the topical use of antibacterial, anti-allergic
steroids. Prevention of further scratching is necessary and psychiatric assis-
tance in solving the basic problem may be required.
OTITIS EXTERNA HAEMORRHAGICA
During certain epidemics of influenza the infection shows a predilection to
attack the ear, and the patient complains of severe earache and tinnitus. On