Comparative Study of Aural Packing with Antibiotic and Steroid Cream with Antibiotic and Steroid Ear Drops in Acute Otitis Externa

Abstract

Acute Otitis Externa (AOE) is a common inflammatory condition of the external auditory canal, typically presenting with acute pain, itching and swelling. Treatment usually involves topical antibiotic-steroid therapy, delivered either as aural packing or ear drops. However, the comparative effectiveness of these two methods in relieving pain has not been well established. This study aims to compare the effectiveness of antibiotic-steroid aural packing versus antibiotic-steroid ear drops in reducing pain among patients with AOE. A comparative prospective study was conducted at Nepal Medical College Teaching Hospital from January to June 2025. A total of 112 adults with clinically diagnosed AOE were enrolled and randomized into two groups: Group 1 received neomycin-betamethasone aural packing, and Group 2 received the same medication in ear drop form. Pain was assessed using the Numerical Rating Scale (NRS) on Day 0, Day 3, and Day 7. Both groups showed significant reductions in pain from baseline to Day 3 and Day 7 (p <0.001). Mean pain scores at Day 0, Day 3, and Day 7 were 7.91, 2.43, and 0.05 in Group 1, and 7.54, 2.29, and 0.05 in Group 2. No statistically significant differences were found between groups at any time point (p >0.05). Antibiotic-steroid aural packing and antibiotic-steroid ear drops are equally effective in relieving pain in acute otitis externa. Given the similar outcomes and greater ease of use, ear drops may be preferred as first-line therapy, while packing may be reserved for cases with severe canal edema or poor drop penetration.