ENT

Otitis Externa (Ear Canal Infection after Match-stick Use)

Severe earache with a history of match-stick use, a tender tragus and pinna, and an inflamed ear canal with fever.

ICD-10: —
Source: OPD handbook pp.120–121
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Severe earache
History of match-stick use positive

Diagnosis

Tender tragus and pinna
Ear canal and ear show signs of inflammation: swollen, redness, tenderness positive, elevated temperature
Vitals: temperature 100–102 °F, pulse tachycardia

Treatment

Step 1 of 4

1. First 24 hours

Keep an ichthammol wick (as written 'Icthamol wig') for 24 hours
Injection: Inj Toradol (ketorolac) IM stat, or Inj Voren IM stat

Prescription

Ichthammol wick (Icthamol wig)Topical anti-inflammatory ear pack

DoseKeep in the ear for 24 hours

Brands Generic / hospital supply

Ketorolac injectionNSAID injection

DoseIM stat

Brand Inj Toradol

Diclofenac sodiumNSAID

DoseIM stat

Brand Inj Voren

Also sold as Voren, Diclo, Dicloran

Step 2 of 4

2. Oral antibiotics, NSAIDs, serratiopeptidase, PPI

Augmentin and Caricef are the drugs of choice
Danzen DS (serratiopeptidase) is specific for reducing inflammation (swelling)
Cap Ruling 20 mg to prevent GI upset

Prescription

Amoxicillin + Clavulanic acidPenicillin antibiotic + β-lactamase inhibitor

DoseTDS

Brand Tab Augmentin 625 mg

Also sold as Augmentin, Co-Amoxiclave, Calamox

Caution: Penicillin allergy; Cholestatic jaundice risk with prolonged use

Cefixime3rd-generation cephalosporin

DoseOD

Brand Tab Caricef 400 mg

Also sold as Cefspan, Cefim, Caricef, Tixomer, Cefiget

Rising resistance in Salmonella Typhi; not reliable as a sole agent in XDR typhoid.

NaproxenNSAID

DoseBD

Brand Tab Neoprox 500 mg

Also sold as Neoprox, Neopron, Flexin, Synflex

PiroxicamNSAID

DoseBD

Brand Tab Pytex 20 mg

Also sold as Brysk, Pytex, Brexin, Feldene

SerratiopeptidaseProteolytic enzyme (anti-inflammatory)

Dose10 mg BD

Brand Danzen DS

OmeprazoleProton pump inhibitor

DoseWith NSAIDs

Brand Cap Ruling 20 mg

Also sold as Risek, Teph, Ruling, Ruling sachet, Omega

Step 3 of 4

3. Follow-up after 24 hours

Remove the ichthammol wick
Start topical antibiotic + steroid: Cipotic-D ear drops (ciprofloxacin + dexamethasone), 3+3+3 drops

Prescription

Ciprofloxacin + Dexamethasone ear dropsTopical antibiotic + steroid

Dose3+3+3 drops (morning, noon, evening)

Brand Cipotic-D ear drops

Step 4 of 4

4. Counselling (Urdu notes)

Do not put match-sticks in the ear
Keep the ear dry; do not let water in
Apply oil on cotton while bathing and place it in the ear
Avoid the advice of relatives