The present study was undertaken to compare the clinical benefits of prescribing ear drops containing 0.05% solution of betamethasone dipropionate (BD), and ear drops containing hydrocortisone with oxytetracycline hydrochloride and polymyxin B (HCPB), for topical treatment of external otitis.

Fifty-one patients were enrolled in this open randomized, parallel-group, multicentre study,performed in eight different ENT departments. The patients were randomly assigned to one of thetwo treatment groups: BD (n= 26) and HCPB (n= 25). Only ENT specialists investigated the patients. Bacterial and fungal cultures were raised on days 1 and 11, using swabbedmaterial from ear canals. Twice daily the patients recorded their symptoms during the acute phase, using special diary cards.

BD proved a significantly more effective cure than HCPB during the acute phase of external otitis and afforded a lower relapse frequency during a six-month follow-up period. The patients of the BD group were significantly less troubled by itching (p <0.01) than those in the HCPB group. On day 11, at the end of the acute phase, growth of bacteria (p= 0.03) and fungi (p < 0.01) was less frequent in the BD group than inthe HCPB group. No serious adverse events occurred, and those minor events observed were comparable between the two groups.

Our conclusion is that the group III steroid solution, BD, cured the external otitismore effectively than did the HCPB solution, whether infected by bacteria or by fungi. No difference was evident regarding adverse effects. Furthermore, price favours a solution without any antibiotic component. In view of these observations, a group III steroid solution ought to be the preferred remedy for external otitis, whether infected or not.

Electrocautery excision (hot dissection) and scissor/snare dissection (cold dissection) are two popular methods used in tonsillectomy. The former causes relatively more post-operative pain but takes less time to perform and is associated with less intra-operative and immediate post-operative bleeding than the latter. To explore post-operative pain control in patients undergoing electrodissection tonsillectomy, a prospective, randomized, one-blind study was designed involving local injections of steroid into the pillar and tonsil bed. The pain levels among the topical injection, deltoid muscle injection and the control group were scored and analyzed. Local steroid injection was found to significantly abate the post-tonsillectomy pain.

The effectiveness of a Eutectic Mixture of Local Anaesthetics (EMLA cream) for pain control during renal extracorporeal shock wave lithotripsy (ESWL) was evaluated in a group of 20 patients who had not been able to tolerate a previous session without intravenous (i.v.) analgesia. EMLA cream (10 g) was applied on the skin over the area (64–100 cm2) where the shock waves were to be focussed. A second generation lithotriptor Siemens Lithostar was used. The following measurements were made: the shock wave (kV) maximum voltage, the number of successful stone fragmentations (SSF), the visual analogue scale score (0–10) for pain (VAS), and the tolerance scale score (1–4) for the tolerance for the procedure. Significantly higher voltage (17.9±0.6 kV vs. 16.2±0.8 kV), lower VAS scores (5.9±1.1 vs. 8.7±1.3), lower TS score (2.3±0.6 vs. 3.6±0.6) and a higher number of SSF (18 vs. 5) were found in those patients for whom EMLA cream was used. Intravenous analgesia was not needed in nine patients. Nine patients received fentanyl 0.05 mg, one 0.10 mg and another 0.15 mg. These favourable results were attributed both to the sequence of gradual voltage increments used and to the cutaneous analgesia produced by EMLA cream.