Otitis externa

Background

Microbiology

1. Pseudomonas
2. Staph epidermidis/aureus
3. Strep
4. Anerobes
5. Fungal infection may present after Abx tx

Risk Factors

1. Swimming
2. Excessive Q-tip use

Diagnosis

1. Otalgia
   1. Elicited by tragal pressure, pulling the auricle superiorly
2. Pruritis
3. Discharge
4. Hearing loss

Differential Diagnosis

1. Necrotizing otitis externa
   1. Spread of infection to soft tissue, cartilage, bone of temporal region
   2. Most common in elderly, diabetic patients
   3. Granulation tissue often seen in the ear canal floor
   4. Suspect if fever, severe otalgia, facial paralysis/meningeal signs
   5. Prompt referral to ENT; treat with anti-pseudomonal agents
2. Otomycosis
   1. Pts complain more of itching than pain
   2. Characteristic appearance on exam; like mold growing on spoiled food
   3. Treatment
      1. Cleaning of ear canal
      2. Topical antifungal
3. Contact dermatitis
4. Chronic suppurative otitis media
   1. Ear canal findings are usually mild compared with bacterial external otitis

Treatment

1. Clean the ear canal
   1. Cerumen wire loop or cotton swab
   2. 1:1 dilution of 3% hydrogen peroxide if TM is visible and intact
2. Topical antibiotic therapy
   1. Floxin Otic: 5 drops in affected ear BID x 7 days
   2. Cipro HC Otic: 3 drops in affected ear BID x 7 days
      1. Contains hydrocortisone = faster healing
   3. Cortisporin Otic suspension: 4 drops TID x 7 days
      1. Avoid in pts with perforated TM
3. Analgesia
   1. NSAIDs
4. Avoiding promoting factors
   1. Keep ear canal dry
   2. Abstain from water sports for 7-10 days
5. Follow-up
   1. 1-2 weeks for pts with moderate disease

See Also

Otitis Media (Peds)

Source

UpToDate

Tintinalli