Randomized trial on the treatment of oedematous acute otitis externa using ear wicks or ribbon gauze: clinical outcome and cost.

Acute otitis externa is a common condition that can be extremely painful. When there is considerable canal oedema, packing is necessary to facilitate the passage of medication. The experience at the Royal Victoria Eye and Ear Hospital is that ear wicks generally require removal in two to three days by medical staff and can be labour intensive as they often involve serial removals following re-insertions. Alternatively, medicated ribbon gauze is cheap and can be removed by the patient at home. Ear wick and mediated ribbon gauze were investigated by a prospective randomized trial involving 94 patients. Fewer out-patient visits were required for the ribbon gauze group (two vs. three, p<0.0001) with considerably less material and labour costs than the wick group. Similar resolution rates were achieved (70 per cent vs. 64 per cent, p = 0.58). Following development of guidelines, the proportion of otitis externa patient reviews in the accident and emergency department declined from 49 per cent to 36 per cent. Compared with the ear wick, medicated ribbon gauze is a cost-effective method of treating oedematous acute otitis externa.