Advice on the management of otitis externa can be found on the NICE CKS website (see link below) and the antimicrobial guidelines.
Caution: in view of reports of ototoxicity, manufacturers contraindicate treatment with drops containing aminoglycosides (e.g. gentamicin) or polymixins in patients with a perforated tympanic membrane (eardrum) or patent grommet. However, some specialists do use these drops in the presence of a perforation or patent grommet in patients with chronic suppurative otitis media and when other measures have failed for otitis externa; treatment should only be considered by ENT specialists in the following circumstances:
- Drops should only be used in the presence of obvious infection.
- Treatment should be for no longer than 2 weeks.
- Patients should be counselled on the risk of ototoxicity and given justification for the use of these topical antibiotics.
- Baseline audiometry should be performed, if possible, before treatment is commenced.
Clinical expertise and judgement should be used to assess the risk of treatment versus the benefit to the patient in such circumstances.