Otitis externa: Difference between revisions
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===Microbiology=== | ===Microbiology=== | ||
#Pseudomonas | #Pseudomonas | ||
# | #Staph epidermidis/aureus | ||
# | #Strep | ||
# | #Anerobes | ||
#Fungal infection may present after Abx tx | #Fungal infection may present after Abx tx | ||
===Risk Factors=== | ===Risk Factors=== | ||
#Swimming | #Swimming | ||
# | #Excessive Q-tip use | ||
==Diagnosis== | ==Diagnosis== | ||
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#Pruritis | #Pruritis | ||
#Discharge | #Discharge | ||
#Hearing loss | #Hearing loss | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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##Most common in elderly, diabetic patients | ##Most common in elderly, diabetic patients | ||
##Granulation tissue often seen in the ear canal floor | ##Granulation tissue often seen in the ear canal floor | ||
##Suspect if fever, severe otalgia, facial paralysis/meningeal signs | |||
##Prompt referral to ENT; treat with anti-pseudomonal agents | ##Prompt referral to ENT; treat with anti-pseudomonal agents | ||
#Otomycosis | #Otomycosis | ||
##Pts complain more of itching than pain | ##Pts complain more of itching than pain | ||
##Characteristic | ##Characteristic appearance on exam; like mold growing on spoiled food | ||
##Treatment | ##Treatment | ||
###Cleaning of ear canal | ###Cleaning of ear canal | ||
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==See Also== | ==See Also== | ||
[[Otitis Media (Peds)]] | |||
==Source== | ==Source== | ||
UpToDate | UpToDate | ||
Tintinalli | |||
[[Category:ENT]] | [[Category:ENT]] | ||
[[Category:ID]] | [[Category:ID]] |
Revision as of 04:01, 14 June 2011
Background
Microbiology
- Pseudomonas
- Staph epidermidis/aureus
- Strep
- Anerobes
- Fungal infection may present after Abx tx
Risk Factors
- Swimming
- Excessive Q-tip use
Diagnosis
- Otalgia
- Elicited by tragal pressure, pulling the auricle superiorly
- Pruritis
- Discharge
- Hearing loss
Differential Diagnosis
- Necrotizing otitis externa
- Spread of infection to soft tissue, cartilage, bone of temporal region
- Most common in elderly, diabetic patients
- Granulation tissue often seen in the ear canal floor
- Suspect if fever, severe otalgia, facial paralysis/meningeal signs
- Prompt referral to ENT; treat with anti-pseudomonal agents
- Otomycosis
- Pts complain more of itching than pain
- Characteristic appearance on exam; like mold growing on spoiled food
- Treatment
- Cleaning of ear canal
- Topical antifungal
- Contact dermatitis
- Chronic suppurative otitis media
- Ear canal findings are usually mild compared with bacterial external otitis
Treatment
- Clean the ear canal
- Cerumen wire loop or cotton swab
- 1:1 dilution of 3% hydrogen peroxide if TM is visible and intact
- Topical antibiotic therapy
- Floxin Otic: 5 drops in affected ear BID x 7 days
- Cipro HC Otic: 3 drops in affected ear BID x 7 days
- Contains hydrocortisone = faster healing
- Cortisporin Otic suspension: 4 drops TID x 7 days
- Avoid in pts with perforated TM
- Analgesia
- NSAIDs
- Avoiding promoting factors
- Keep ear canal dry
- Abstain from water sports for 7-10 days
- Follow-up
- 1-2 weeks for pts with moderate disease
See Also
Source
UpToDate
Tintinalli