Hornigold Rachael, Gillett Darren, Kiverniti Elina, Harries Meredydd
Department of Otorhinolaryngology, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BE, UK.
Eur Arch Otorhinolaryngol. 2008 Oct;265(10):1199-203. doi: 10.1007/s00405-008-0620-1. Epub 2008 Mar 7.
We compared the use of glycerol and icthammol (G&I) ribbon gauze versus topical antibiotic and steroid drops in the management of otitis externa. Patients presenting with acute otitis externa were systematically recruited from attendance in the ENT emergency clinic. Exclusion criteria were age <18 years, diabetic patients, and those who had been previously treated for otitis externa by the department within the last month. A total of 43 patients were recruited with 48 infected ears, the mean patient age was 47 years, (range 18-80 years). Patients were randomised to either insertion of a G&I ribbon gauze or topical ear drops by means of a ballot with no stratification. All patients were reviewed 5 days later. Patients were asked to comment on their pain using the ten point visual analogue pain score. Oedema of the canal wall, presence of debris and visibility of the tympanic membrane were graded on microscopy. Patient satisfaction and return to work were assessed. There was a statistically significant decrease in the pain score between each visit for the entire group of patients and decrease in canal wall swelling (P < 0.001). There was no significant difference between drops and ribbon gauze in terms of pain relief, canal wall oedema, or aural discharge. Following microbiological analysis, 27.8% of bacteria were resistant to neomycin. The cost of treatment with G&I is less than a third of that for topical antibiotic-steroid drops and requires less patient compliance. Patient concerns with the ribbon gauze included its cosmetic appearance and loss of hearing and with drops included frequency of application. We recommend the use of G&I ribbon gauze as first-line treatment, particularly for those who have had allergies to carriers of drops, those that are poorly compliant or with poor manual dexterity, for example patients with rheumatic hands.
我们比较了甘油和鱼石脂（G&I）带状纱布与外用抗生素和类固醇滴剂在治疗外耳道炎中的应用。从耳鼻喉科急诊诊所就诊的患者中系统招募患有急性外耳道炎的患者。排除标准为年龄<18岁、糖尿病患者以及过去一个月内曾在该科室接受过外耳道炎治疗的患者。共招募了43名患者，患耳48只，患者平均年龄为47岁（范围18 - 80岁）。通过无分层抽签的方式将患者随机分为插入G&I带状纱布组或外用耳滴剂组。5天后对所有患者进行复查。要求患者使用十点视觉模拟疼痛评分对其疼痛情况进行评价。通过显微镜检查对外耳道壁水肿、碎屑情况以及鼓膜可见度进行分级。评估患者满意度和恢复工作情况。整个患者组每次就诊之间的疼痛评分有统计学显著下降，外耳道壁肿胀也有所减轻（P < 0.001）。在疼痛缓解、外耳道壁水肿或耳漏方面，滴剂和带状纱布之间没有显著差异。经过微生物分析，27.8%的细菌对新霉素耐药。G&I治疗的成本不到外用抗生素 - 类固醇滴剂的三分之一，且患者依从性要求较低。患者对带状纱布的顾虑包括其外观和听力丧失，对滴剂的顾虑包括用药频率。我们建议将G&I带状纱布作为一线治疗方法，特别是对于那些对滴剂载体过敏、依从性差或手部灵活性差的患者，例如患有风湿性手部疾病的患者。
