H66.1-3
DESCRIPTION
A purulent discharge from the ear for more than 2 weeks.
If the eardrum has been ruptured for 2 weeks or longer, a secondary infection with multiple organisms usually occurs. Multiple organism infection often makes oral antibiotic treatment ineffective and patients may need to be referred.
TB is an important cause of a chronically discharging ear in South Africa.
If pain is present, suspect another condition or complications.
Note:
- A chronically draining ear can only heal if it is dry.
- Drying the ear is time consuming but is the most effective treatment.
- HIV status should be established in chronic otitis media.
GENERAL MEASURES
Dry mopping is the most important part of the treatment. It should be demonstrated to the patient.
- Roll a piece of clean absorbent cloth into a wick.
- Carefully insert the wick into the ear with twisting action.
- Remove the wick and replace with a clean dry wick.
- Repeat this until the wick is dry when removed.
Do not leave anything in the ear.
Avoid getting the inside of the ear wet while swimming and bathing.
Exclude TB as a cause.
MEDICINE TREATMENT
After cleaning and drying the ear:
- Acetic acid 2% in alcohol, topical, 3–4 drops instilled into the ear every 6 hours for 5 days.
- Ciprofloxacin, drops, 3 mg/mL, 3–4 drops instilled into the ear every 8 hours for 7 days after mopping.
For pain:
- Paracetamol, oral, 1 g 4–6 hourly when required.
- Maximum dose: 15 mg/kg/dose.
- Maximum daily dose: 4 g in 24 hours.
If pain is not controlled, see Pain.
REFERRAL
- Focal neurological signs such as facial nerve palsy.
- Vomiting or drowsiness.
- Swelling and pain on palpation of the mastoid process.
- No improvement after 4 weeks.
- Any attic perforation.
- Any perforation not progressively improving after 3 months or closed by 6 months, even if dry.
- Moderate or severe hearing loss.
- Effusion.