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  3. Clinical efficacy of three common treatments in acute otitis externa in primary care: randomised controlled trial
Primary Care

Clinical efficacy of three common treatments in acute otitis externa in primary care: randomised controlled trial

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7425.1201 (Published 20 November 2003) Cite this as: BMJ 2003;327:1201

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Acetic acid may be preferable to antibiotic in the therapy of otitis externa

Dr van Balen and colleagues do not give details of the age of their
patients. In tertiary care, at least, the incidence of topical
sensitivity to antibiotic preparations in otitis externa patients can be
as high as 58%. Older patients seem more likely to have this allergy,
which may be confirmed only on patch testing. [1]

Neomycin is a frequent culprit. The incidence of iatrogenic
exacerbation of otitis externa may thus be lower by using the combination
of steroid with acetic acid, rather than with antibiotic, particularly in
patients over the age of 40.

Yours etc

1. Smith IM et al Clin Otolaryngology 15: 155-8, 1990

Competing interests:
None declared

Competing interests: No competing interests

27 November 2003
Janet A Wilson
Prof Otolayngology Head Neck Surgery, University of Newcastle
Freeman Hospital Newcastle upon Tyne NE7 7DN

A question of statistics

In the abstract to their article in the BMJ of 22nd November, van
Balen et al compare different treatments for otitis externa. They
conclude that drops containing corticosteroids (whether or not they are
combined with acetic acid or antibiotic) are more effective than acetic
acid ones.

I am not a statistician and may have misunderstood the results, but
the 95% confidence intervals given for the duration of symptoms seem to
overlap quite markedly and the data on overall cure rates appears
incomplete. I would be grateful for some clarification on this as the
treatment of otitis externa is an important topic and I am uncertain
whether the extra expense of steroid ear drops is justified by the
evidence given.

Competing interests:
None declared

Competing interests: No competing interests

23 November 2003
Peter J T Balfour
Career Grade Trainee in Family Planning & Reproductive Health Care
Conwy and Denbighshire NHS Trust, c/o Glan Clwyd Hospital, Rhyl, Denbighshire, LL18 5UJ.
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