title: Assessment and management of chronic otitis externa.
abstract: OBJECTIVE
  Chronic otitis externa (COE) remains a frustrating problem for both patient and physician. The end stage of disease, medial fibrosing otitis externa, is very challenging to repair. New and old therapies and promising approaches to the treatment of this often recalcitrant problem are presented in this review.
  
  
  RESULTS
  Tacrolimus, a nonsteroidal immunosuppressant, and fluocinolone acetonide oil 0.01%, a medium-high potency steroid preparation, may offer additional therapeutic options in the struggle against this inflammatory ear canal/skin condition of often unknown cause. Relative potencies of many steroid preparations will be presented along with several treatment strategies for controlling COE. Underlying autoimmune problems such as Sjögren's disease, sarcoidosis, and amyloidosis must be searched and, if present, addressed and treated for resolution of symptoms. Cutting edge therapies, including use of bacteriophages and inflammatory proteases, will also be reviewed.
  
  
  CONCLUSIONS
  No single therapy will be successful for every patient with COE. The search for an underlying cause, the removal of all possible irritants to the ear canal skin (e.g. Q-tips, water), debridement, and both topical and occasionally, systemic therapy will control (not cure …) the disease process in the vast majority of patients.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA. Bwk2n@virginia.edu
authors.forename: Bradley W
authors.initials: BW
authors.lastname: Kesser
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications; D001435:Bacteriophages; D002908:Chronic Disease; D003646:Debridement; D005446:Fluocinolone Acetonide / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D009181:Mycoses / Q000150:complications; D010032:Otitis Externa / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D010447:Peptide Hydrolases / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D005446:Fluocinolone Acetonide; C035394:fluocinolone; D010447:Peptide Hydrolases; D016559:Tacrolimus