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Patient
Group Direction for the treatment of itchy ears; inflamed
or traumatised skin; minor otitis externa or inflamation following
removal of hard excess wax
1.
Clinical condition
Patients
presenting with itchy ears of normal appearance; early symptoms
of otitis externa; inflamed or with cotton bud trauma or inflamed
following excess wax removal.
Objective
To
prevent minor ear problems exacerbating into major long term
problems requiring
topical antibiotic treatment. To administer preventive treatment
following ear wax removal
Guidelines
Based
on BNF directions and Primary Ear Care guidelines for patients
2.
Patients
Inclusion
criteria
On
examination: ear meatus is seen to be traumatised; inflammed;
dry and flaky; or signs of seborrhoeic dermatitis. Minor otitis
externa. Also identified through patient description. inflamed
mastoid cavity following toilet.
Exclusion
criteria
Obvious
infected debris and discharge in the ear meatus. Children
under 8 years. Signs and symptoms of otitis media. More major
otitis externa. Middle ear disease.
Excluded
patients and those refusing treatment
Refer
to general practitioner. Treat more major problems according
to PGD for relevant ear problem.
3.
Treatment
Name,
Dose, Method and route
Betamethasone
0.1% (as Valerate) and Clioquinol 3% in ointment base. Aural
toilet first.
Paint approx. 0.5 - 1G onto affected area using cotton wool
wound onto a jobson horne
probe or for initial treatment apply ointment on a wick for
48 hours. Use direct vision by
a mirror and light source or a versabrite head light. Clinical
judgement will determine
treatment related to individual patient need at presentation.
"One off" application frequently
sufficient but may be repeated in one month up to a maximum
of 3 times. For on going
self care this application can be followed by Flumethasone
Pivilate 0.02% with
Cliquinol 1% ear drops(Anti-inflammatory/anti-septic properties)or
Galacial Acetic acid spray
Patient
advice
Advise
about nature of treatment. Advise re ointment staining clothing.
Warn about
possible sensitivities to treatment and instruct accordingly.
Advise, keep ears dry.
.
Follow
up care
Review
should discomfort persist. If no improvement after 2 applications
take a swab
for C&S. Check for adverse reaction - if worsening symptoms
could be allergic reaction
remove wick and treat with glycerine and ichthammol dressing
or 1% Hydrocortisone.
Reporting
procedure
Record
in patient's notes according to UKCC guidelines. Contact GP
to report any
adverse reactions or requirements for referral for secondary
advice.
Information
recorded
Presenting
problem, previous episodes, description of findings. Treatment
given
and method of application. Any follow-up.
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