Comparison of Efficacies of 10% Ichthammol Glycerine and 3% Ciprofloxacin–1% Dexamethasone in Treatment of Acute Otitis Externa in Terms of Pain Reduction

Abstract

Background: Acute otitis externa (AOE) is a prevalent inflammatory condition of the external auditory canal (EAC) in which ear pain is a prominent symptom. Both topical antibiotic combinations with steroid and ichthammol glycerine are used for treatment, but there is still limited comparative evidence about early pain relief.

Objective: To compare the efficacy of 3% ciprofloxacin–1% dexamethasone with 10% ichthammol glycerine in reducing pain among patients with moderate-to-severe acute otitis externa.

Material and Methods: It was a randomized controlled trial in the Department of Otorhinolaryngology, Head and Neck Surgery, Pakistan Institute of Medical Sciences, Islamabad from May to November 2018. 70 patients age 12 to 60 years were divided into 2 groups equally. Group A was given 3% ciprofloxacin – 1% dexamethasone wick and Group B was given 10% ichthammol glycerine wick. The pain measured on a Visual Analogue Scale (VAS) at day 3 and baseline. The day-3 pain-response criterion was used to measure treatment efficacy. 

Results: Baseline VAS scores were comparable between Group A and Group B (6.74±1.12 vs 6.71±1.15). By day 3, mean VAS decreased to 2.43±1.36 and 3.63±2.04, respectively. Ciprofloxacin–dexamethasone resulted in a greater mean reduction in pain score compared to the other group (4.31±1.32 vs 3.09±1.44; p<0.001). Overall efficacy was 77.1% versus 40.0% (p=0.002). These differences were found in each sex and age category, and were more pronounced in the ciprofloxacin–dexamethasone group in all of the subgroups. 

Conclusion: 3% ciprofloxacin–1% dexamethasone provided superior early pain control compared with 10% ichthammol glycerine in moderate-to-severe acute otitis externa.

Keywords: Acute otitis externa; Ciprofloxacin; Dexamethasone; Ichthammol glycerine; Otalgia; Visual Analogue Scale.