Contact hypersensitivity in patients with chronic otitis externa

Smith, Ian M.; Keay, D. G.; Buxton, P K

doi:10.1111/j.1365-2273.1990.tb00449.x

Cited by 35 publications

(31 citation statements)

References 12 publications

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“…3,5,19,22 Neomycin tends to be sensitising in 5-18% of patients, and can incite contact dermatitis (Figure 2). 1,4,22,25,26 If acute OE fails to completely resolve, the physician should be aware that the preservatives, benzalkonium chloride, thimerosal, and propylene glycol, can incite local sensitisation. [1][2][3][4]9,15,20,[24][25][26] The fluoroquinolone preparations require only twicedaily dosing, and some are approved for use with a nonintact tympanic membrane.…”

Section: Treatmentmentioning

confidence: 99%

“…1,4,22,25,26 If acute OE fails to completely resolve, the physician should be aware that the preservatives, benzalkonium chloride, thimerosal, and propylene glycol, can incite local sensitisation. [1][2][3][4]9,15,20,[24][25][26] The fluoroquinolone preparations require only twicedaily dosing, and some are approved for use with a nonintact tympanic membrane. The addition of a steroid to a fluoroquinolone diminishes the symptomatic period by 0.8 days, and must be balanced against the small risk of the steroid acting as a sensitising agent.…”

Section: Treatmentmentioning

confidence: 99%

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Otitis externa: review and clinical update

Osguthorpe

2011

South African Family Practice

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Otitis externa can take an acute or a chronic form, with the acute form affecting four in 1 000 persons annually and the chronic form affecting 3-5% of the population. Acute disease commonly results from bacterial (90% of cases) or fungal (10% of cases) overgrowth in an ear canal subjected to excess moisture, or to local trauma. Chronic disease often is part of a more generalised dermatologic or allergic problem. Symptoms of early acute and most chronic disease include pruritus and local discomfort. If left untreated, acute disease can be followed by canal oedema, discharge, and pain, and eventually by extra-canal manifestations. Topical application of an acidifying solution is usually adequate in treating early disease. An antimicrobial containing ototopical is the preferred treatment for later-stage acute disease, and oral antibiotic therapy is reserved for advanced disease or those who are immunocompromised. Preventative measures reduce recurrences, and typically involve minimising ear canal moisture, trauma, or exposure to materials that incite local irritation or contact dermatitis.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Otitis externa: review and clinical update

Osguthorpe

2011

South African Family Practice

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“…Neomycin is the most common substance, causing reactions in about 5% to 15% of patients with chronic external otitis. 62 Patch testing has demonstrated that 13% of normal volunteers are hypersensitive to neomycin. 63 A maculopapular and often eczematous eruption on the conchal bowl and in the ear canal is consistent with an allergic reaction to a topical agent; an erythematous streak may extend down the pinna where drops contact the auricular skin.…”

Section: Dermatoses Of the Ear Canalmentioning

confidence: 99%

“…46,110 Conversely, about 30% to 60% of patients with chronic or eczematous external otitis develop a contact dermatitis, most often to aminoglycosides such as neomycin and framycetin. 62,[131][132][133][134][135] No studies are limited specifically to patients with recurrent AOE, chronic external otitis, or eczematous external otitis, but it would appear prudent to avoid using aminoglycoside drops in these populations.…”

Section: Adverse Events Adherence To Therapy and Costmentioning

confidence: 99%

Clinical Practice Guideline: Acute Otitis Externa

Rosenfeld

Schwartz

Cannon

et al. 2014

Otolaryngol.--head neck surg.

133

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Objective. This clinical practice guideline is an update and replacement for an earlier guideline published in 2006 by the American Academy of Otolaryngology-Head and Neck Surgery Foundation. This update provides evidence-based recommendations to manage acute otitis externa (AOE), defined as diffuse inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. The variations in management of AOE and the importance of accurate diagnosis suggest a need for updating the clinical practice guideline. The primary outcome considered in this guideline is clinical resolution of AOE.Purpose. The primary purpose of the original guideline was to promote appropriate use of oral and topical antimicrobials for AOE and to highlight the need for adequate pain relief. An updated guideline is needed because of new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. The target patient is aged 2 years or older with diffuse AOE. Differential diagnosis will be discussed, but recommendations for management will be limited to diffuse AOE, which is almost exclusively a bacterial infection. This guideline is intended for primary care and specialist clinicians, including otolaryngologists-head and neck surgeons, pediatricians, family physicians, emergency physicians, internists, nurse practitioners, and physician assistants. This guideline is applicable in any setting in which patients with diffuse AOE would be identified, monitored, or managed.Action Statements. The development group made strong recommendations that (1) clinicians should assess patients with AOE for pain and recommend analgesic treatment based on the severity of pain and (2) clinicians should not prescribe systemic antimicrobials as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy. The development group made recommendations that (1) clinicians should distinguish diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the external ear canal; (2) clinicians should assess the patient with diffuse AOE for factors that modify management (nonintact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, prior radiotherapy); (3) clinicians should prescribe topical preparations for initial therapy of diffuse, uncomplicated AOE; (4) clinicians should enhance the delivery of topical drops by informing the patient how to administer topical drops and by performing aural toilet, placing a wick, or both, when the ear canal is obstructed; (5) clinicians should prescribe a non-ototoxic preparation when the patient has a known or suspected perforation of the tympanic membrane, including a tympanostomy tube; and (6) clinicians should reassess the patient who fails to respond to the initial therapeutic option within 48 to 72 hours to confirm the diagnosis of diffuse AOE and to exclude other causes of illness. Keyw...

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“…Alerjik kontakt dermatitte en sık neden olan ajan olarak neomisin tespit edilmiş (%38) ve kullanılmaması gerektiği bildirilmiştir. [8] Önder ve ark.nın [9] çalışmasında eksternal otit tedavisinde kullanılan topikal ilaçlardan neomisinin %15, gentamisinin ise %10 oranında alerjik cilt reaksiyonlarına neden olduğu bildirilmiştir. Bu nedenle tedaviye rağmen kronik eksternal otit ve kaşıntısı sebat eden vakalarda spesifik epidermal yama testleri ile bu ilaçlara karşı alerjik reaksiyon gelişip gelişmediğinin tespit edilmesi gerekmektedir.…”

Section: Discussionunclassified

A rare side effect due to topical gentamicin use: Auricular necrosis

Dursun¹

2017

Kulak Burun Bogaz Ihtis Derg

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ÖZEksternal otit dış kulak yolu ve aurikulanın enflamasyonu ile karakterize sık görülen bir durumdur. Tedavi için kullanılan topikal ajanlar kontakt dermatite neden olabilir. Bu yazıda, sağlık ocağı biriminde akut eksternal otit tanısı ile gentamisin tedavisi başlanan ancak tedavisinin üçüncü gününde kulağında siyah renkli lezyonlar, ağrı ve akıntı yakınması ile kliniğimize başvuran 48 yaşında bir erkek hasta sunuldu. Fizik muayenesinde dış kulak yolu kıkırdak kısmında ve kavum konkada yaygın cilt nekrozu görüldü. Malign eksternal otit ön tanısı ile yüksek rezolüsyonlu temporal kemik bilgisayarlı tomografisi çekildi. Kulak kültürü ve nekrotizan alandan biyopsi yapıldı. İntravenöz piperasilin-tazobaktam tedavisi başlandı. Radyolojik ve kültür inceleme sonuçlarının normal çıkması üzerine topikal gentamisin uygulamasına bağlı şimik reaksiyon düşünüldü. Debridman ve yara bakımının ardından hasta komplikasyonsuz taburcu edildi. Dış kulak yolunda ve aurikulada yaygın nekroz ile başvuran hastalarda ayırıcı tanıda ilk olarak yüksek mortalite ve morbidite oranları nedeniyle malign eksternal otit ekarte edilmeli ve aynı klinik tabloya neden olabilecek ilaç reaksiyonları göz ardı edilmemelidir.Anahtar Sözcükler: Alerjik kontakt dermatit; auriküler nekroz; gentamisin. ABSTRACTExternal otitis is a common condition characterized by inflammation of external auditory canal and auricle. Topical agents used for treatment may cause contact dermatitis. In this article, we present a 48-year-old male patient admitted to our clinic with complaint of black colored lesions, pain, and discharge on his ear on third day after the start of gentamicin treatment by a primary health care unit due to a diagnosis of acute external otitis. In physical examination, we observed widespread skin necrosis on cartilage part of external auditory canal and cavum conchae. High resolution computed tomography of the temporal bone was performed with a prediagnosis of malignant external otitis. Ear culture and biopsy from the necrotic region were conducted. Intravenous piperacilline-tazobactam treatment was started. Upon normal results from radiologic and culture examinations, we considered a chemical reaction due to topical gentamicin application. Patient was discharged after debridement and wound care without any complications. Because of its high morbidity and mortality rates, malignant external otitis should be the first to eliminate in the differential diagnosis in patients that apply with widespread necrosis on external auditory canal and auricle and drug reactions that may cause the same clinical picture should not be ignored.

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Contact hypersensitivity in patients with chronic otitis externa

Cited by 35 publications

References 12 publications

Otitis externa: review and clinical update

Otitis externa: review and clinical update

Clinical Practice Guideline: Acute Otitis Externa

A rare side effect due to topical gentamicin use: Auricular necrosis

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