OTITIS-EXTERNA - MANAGEMENT OF THE RECALCITRANT CASE

Most cases of otitis externa respond to routine treatment, however, th ere is a subset of patients who frequently develop otitis externa that is usually severe and recalcitrant to routine therapy. These patients include the immunocompromised, those with AIDS, transplant recipients , severe diabetics, patients treated with high dose steroids or chemot herapeutic agents, and those who are malnourished or are chronically i ll. Local factors that lead to worsening of otitis externa include der matitides and prior local irradiation. Patients who find topical thera py painful may be noncompliant with medications, and they too, may dev elop recalcitrant otitis externa. For successful treatment, a broad un derstanding of external auditory canal anatomy, the microbiology and p athophysiology of otitis externa, and available treatment options, inc luding topical and systemic medications, must be attained. These topic s are reviewed.