![]() Kliegman MD, in Nelson Textbook of Pediatrics, 2020 Treatment However, wicks can harbor bacteria with prolonged retention and cause tissue ingrowth, which results in long-term problems for the patient. Generally, these wicks will fall out of the canal as the edema subsides. Though relatively safe to use, the ear wick is designed for short-term use. Keep the wick moist with drops and leave it in place until the patient is seen again in 24 to 48 hours for removal and further evaluation. The wick swells and helps reduce edema by the antimicrobial and antiinflammatory effects of the solution and through pressure exerted against the walls as it expands. Place this dehydrated and trimmed wick into an edematous canal and apply antibiotic/hydrocortisone drops onto it (see Fig. 63.20 A).Īn easier alternative is to use commercially available ear wicks, such as the Pope Merocel ear wick (Medtronic, Langhorne, PA). Withdraw the otoscope and finish by also packing the lateral aspect of the canal. ![]() Using an otoscope and alligator forceps, place the leading edge of the gauze deeply in the canal until it is fully packed. One approach is to place a 0.25-inch strip of Nu-Gauze dressing (Johnson & Johnson, New Brunswick, NJ) covered with an antibiotic and steroid cream (Cortisporin Otic cream, Monarch Pharmaceuticals, Inc., Bristol, TN) into the external acoustic canal in a fashion similar to the technique used for anterior nasal packing. The true benefit of wick implantation is unknown and it is often not performed because it is painful. The wick works as a conduit to deliver the antibiotic solutions to the ear canal. When edema, debris, and exudate are marked enough to impede antibiotic drops from contacting the skin of the canal, use an ear wick. Administer parenteral analgesics if additional control of pain is required. 63.16) as long as the cellulitis has not extended to the tragus or concha. Another approach is to use a local block of the EAC (see Fig. Filling the ear canal with 4% cocaine and waiting 20 minutes for effect will often anesthetize the canal enough for gentle manipulation. For more advanced cases with significant exudate and edema, removal of debris is necessary but intensely painful. ![]() 16,22 Because the inflamed canal is susceptible to trauma, removal of debris by suctioning under direct visualization with the open or operating otoscope head and a 5- or 7-Fr Frazier suction tip may be a better option (see Fig. Perform irrigation only in the absence of TM perforation. ![]() Irrigate the canal gently, but realize that many patients will be cured without extensive débridement. Roberts MD, FACEP, FAAEM, FACMT, in Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care, 2019 Procedureīecause of patient discomfort and canal swelling, use small swabs (e.g., urethral swabs) to gently remove debris.
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