Contact Allergy to Various Components of Topical Preparations for Treatment of External Otitis

Fräki, Jorma E.; Kalimo, Kirsti; Tuohimaa, P; Aantaa, E.

doi:10.3109/00016488509126565

Cited by 62 publications

(34 citation statements)

References 14 publications

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“…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.

128

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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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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.

128

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“…Der Konservierungsstoff Benzalkoniumchlorid kann Allergien auslösen [6] sowie die Fremdkörperabwehr schwä-chen.Letzteres wurde nachgewiesen durch die Hemmung der Funktion des Flimmerepithels und die Hemmung der Beweglichkeit der Zilien [5,12] und der Phagozytoseaktivität der Makrophagen [4].…”

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Vertr�glichkeit und Wirksamkeit von Oxymetazolin* und Xylometazolin bei der Behandlung der akuten Rhinitis

Dorn¹,

Hofmann²,

Knick³

2003

HNO

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“…[11] yaptıkları çalışmada eksternal otit tedavisinde kullanılan topikal ajanların ve hatta bu ajanların içinde bulunan koruyucu maddelerin de (benzalkonyum klorid, tiyomersal, propilen glikol) kontakt alerjik reaksiyonlara neden olabileceğini gös-termişlerdir. Bu maddeler arasında bizim olgumuzun da kullandığı gentamisin kulak damlası içerisinde benzalkonium klorid koruyucu maddesi de bulunmaktadır.…”

Section: Discussionunclassified

“…Bu alerjik dermatit tablosu çoğunlukla kronik eksternal otit ile ilaca bağlı alerjik kontakt dermatitin birbirine karıştığı, ayırt edilmesi zor bir durum olarak karşımıza çıkmaktadır. [3] Ancak yaptığımız literatür taramasında topikal ilaç kullanımına bağlı auriküler nekroz olgusuna rastlamadık. Bu yazıda topikal gentamisin tedavisi sonrası gelişen dış kulak yolu ve aurikula nekrozu olgusu sunulmuş ve literatür eşliğinde tartışılmıştır.…”

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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 Allergy to Various Components of Topical Preparations for Treatment of External Otitis

Cited by 62 publications

References 14 publications

Clinical Practice Guideline: Acute Otitis Externa

Clinical Practice Guideline: Acute Otitis Externa

Vertr�glichkeit und Wirksamkeit von Oxymetazolin* und Xylometazolin bei der Behandlung der akuten Rhinitis

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

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