Objective: Cases of chronic otitis externa (OE) resistant to conventional treatment remain a significant challenge. This paper describes our experience of utilising fluticasone propionate (Flixonase®) drops in the treatment of such cases. Methods: We included a series of patients with resistant chronic OE that were referred to ENT consultant clinic between 2016 and 2018, all of whom failed to respond to the conventional treatments. The patients were prescribed 200 micrograms of Flixonase® once daily and followed up in the clinic to assess response to the treatment. The case notes were reviewed retrospectively. Results: Total of 25 patients identified over 2 years. Patients reported itching as the most common symptom (83%), and skin changes were the most common sign identified under examination (72%). The combination of steroid and antibiotic drops had been the most common treatment modality prescribed. Fluticasone propionate was started a median of 5 months after the diagnosis (range: 0-54 months) with a median treatment duration of 3 months (range: 1-18 months). All 17 patients who attended the follow-up clinic were classified as having been cured. Conclusions: Our findings suggest fluticasone propionate as an exciting and potentially important modality in the treatment of chronic OE cases, especially where all other treatment options have been exhausted.

Treating twenty-five cases of chronic resistant otitis externa with fluticasone propionate (Flixonase®): a case series Utilising Flixonase® in treatment of chronic otitis externaKey points:Chronic cases of otitis externa, resistant to conventional treatments are notoriously difficult to treat, with resolution in these cases challenging.Guidelines suggest the use of corticosteroid in chronic otitis externa, however, there is no specific advice on which corticosteroid to utilise.Our case-series demonstrates the potential benefit of fluticasone propionate in patients who have previously failed a multitude of conventional management options.Despite the limitations of our study, our experience highlights a gap in the literature and suggest fluticasone propionate as an exciting and potentially important tool in the arsenal of the otolaryngologist.