Module 8.6 - Otitis Externa

Question 1

What is otitis externa?

Answer 1

A painful inflammation of the external auditory canal (swimmer’s ear)

Question 2

What are the 6 causes otitis externa?

Answer 2

1. More common in swimmers

2. Bacteria:

1. Pseudomonas aeruginosa (most common pathogenic organism)
2. Staphylococcus aureus (most common organisms in the outer ear)
3. Proteus vulgaris
4. Streptococcus

3. Fungi:

• Most commonly Candida, secondary to prolonged antibiotic use.

4. Trauma:

• May occur through attempts to clean the ear with cotton-tipped swabs or other objects.

5. Allergic reaction to drugs, including topical neomycin, topical benzocaine and topical propylene glycol.

6. Viral

Question 3

What are the subjective/physical exam findings associated with otitis externa?

Answer 3

A. Pain- exacerbated when the auricle or tragus is touched or moved.

B. Decreased hearing or sense of fullness in the ear

C. Fever

D. Lymphadenitis (preauricular, postauricular and anterior cervical triangle)

E. Itching in the auditory canal with outer ear edema

F. Otorrhea, may include the following:

1. Purulent
2. Bloody
3. Serous
4. Yellow-orange cerumen mixture
5. Tympanic membrane is normal or may be erythematous or dull

Question 4

How do you manage otitis externa?

Answer 4

A. Gentle suction and removal of debris from the external auditory canal

B. Antimicrobial ear drops, such as:

1. Cortisporin Otic (combined antibiotic and steroid solution)
2. Cipro HC otic
3. Antimicrobial solution, such as TobraDex
4. Zoto-HC drops

C. A cotton gauze wick may be inserted into the external auditory canal if severe edema is present (remove within 2-3 days of insertion)

D. Oral antibiotics if culture results indicate;

Ciprofloxacin 750mg bid, may be required if infection extends outside the ear canal.

E. Warm compresses to outer ear.

F. Consider corticosteroids (Medrol dosepak), 5 day tapering dose to reduce edema/pain

G. Oral analgesics:

• Such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAID’s), may need opioids (such as hydrocodone/acetaminophen).

H. A 50/50 combination of rubbing alcohol and white vinegar may be applied to the affected ear after swimming or bathing as a preventative measure.

I. Follow up in 1 week for ear check.