Necrotizing otitis externa is difficult to treat, and the mortality rate can be as high as 53 percent. This condition should be suspected when, despite adequate topical treatment, otalgia and headache are disproportionately more severe than the clinical signs or when granulation tissue is apparent at the bony cartilaginous junction. The diagnosis should be confirmed by a computed tomographic (CT) scan or magnetic resonance imaging (MRI). A combination of technetium scanning to detect osteoblastic activity and gallium 67 imaging to detect granulocytic activity can be used in questionable cases and is recommended by some 4 , 25 as a means of monitoring response to treatment. The erythrocyte sedimentation rate (ESR) can also be used to monitor therapeutic response. 25
Because P. aeruginosa and S. aureus are common pathogens in otorrhea, they must be considered at the time of treatment selection. Currently, no narrow-spectrum agent is available for the coverage of these two microbes. For the treatment of acute diffuse otitis externa, polymyxin B-neomycin-hydrocortisone combinations and fluoroquinolones are equally effective, and neither treatment carries known risk. The twice-daily dosing schedule of topical fluoroquinolones may improve compliance. When selecting treatment for acute otitis media with perforation, topical fluoroquinolones represent a good first-line option, although not clearly better than traditional topical therapy. For chronic suppurative otitis media topical fluoroquinolones likely represent the best choice because treatment is long, and repeated therapy is common. 18
You can buy some topical corticosteroids "over-the-counter" without a prescription. For example, for dermatitis, you can buy the steroid cream called hydrocortisone 1% from your pharmacy. Do not apply this to your face unless your doctor has told you to do so. This is because it may trigger a skin condition affecting the face ( acne or rosacea. ) Long-term use may also damage the skin. On your face this would be more noticeable than the rest of your body. So usually only weak steroids are used on the face. Those which are suitable are prescription-only.