Ear OTC - Otitis Externa

Question 1

Give e.g. of outer ear disorders. (3)

Answer 1

Dermatitis - dry, itchy pinna/ear canal irritation. Tx = Emollients

Contact dermatitis: Earring/ear plugs/aids sensitivity. Tx: Topical HC - avoid nickel containing earrings.

Seborrhoeic dermatitis: can affect ear in isolation or with scalp dandruff/eye brow scaling. Eczematous reactions (yeasts). Tx: Anti-fungal shampoo/creams first e.g. Ketoconazole, Steroid drops/creams.

Question 2

Define otitis externa. (4)

Answer 2

Swimmer’s ear:
- Pinna/external ear canal inflammation
- Localised/diffuse
- Acute/chronic

Question 3

What are the predisposing external factors of otitis externa? (6)

Answer 3

Ear Trauma
Use of cotton buds
Syringing
Excessive Moisture
Humid environment
Chemicals - shampoo/hair dye

Question 4

What are the types of otitis externa? (3)

Answer 4

Infective exudate discharged: Bacterial/viral/fungal and after prolonged CS / ABx use.

Reactive: Dermatitis (atopic/contact)

Furuncle (boil-like) Supportive tx with flucloxacillin if severe.

Question 5

What are the symptoms of otitis externa? (6)

Answer 5

Ear canal mild pain
Itching
Impaired hearing (mild)
Foul smelling discharge
Red ear
Swollen /scaly ear

Question 6

What are the treatment options for otitis externa? (2)

Answer 6

Acetic acid 2% spray (Earcalm) - 1st line for mild bact/fungal:
- Adults & > 12 yrs.
- 1 spray TDS = continued 2 days after symptoms resolved.
- Max dose frequency 1 spray every 2-3 hrs.
- Max 7 days use.
- Can cause burning or irritation on application as acidic - advise this to px can affect compliance.
- Less likely to cause super-infection than CS.

Question 7

What advice is given to patients suffering otitis externa? (2)

Answer 7

• Don’t try to clean or clear ear canal with fingers, cotton buds etc. They may scratch/irritate and push wax or dirt further in.
• Stop soap or shampoo from getting in.
• A piece of cotton wool coated in Vaseline placed in the outer ear may help or ear plugs designed for swimming.

Question 8

What are the alarm symptoms for outer ear disorders? (5)

Answer 8

Internal ear pain (infection)
Foreign body (high risk in children)
Otitis Media (ear pain, if eardrum perforates, purulent smelly discharge)
Mastoiditis (px feels unwell, has marked hearing loss or mastoid tenderness/swelling)
Barotrauma: Possible in divers or px who have recently flown or had a blood to the ear