Otitis Externa

Question 1

Otitis Externa Definition

Answer 1

inflammation of the outer ear and ear canal

Question 2

Otitis Externa Causes

Answer 2

most often associated with swimming, local trauma, use of hearing aids, and high, humid temperatures

Question 3

Otitis Externa Therapy

Answer 3

topical antibiotic therapy is usually adequate for treatment of OE

Question 4

Otitis Externa Types

Answer 4

acute and chronic; necrotizing

Question 5

Otitis Externa First Line Treatment

Answer 5

fluoroquinolone drops: not recommended for patients <1 year; use all otic drops for maximum 10 days.
Ofloxacin (not for use < 1year)

Question 6

Otitis Externa Second Line Treatment

Answer 6

combination neomycin/polymyxin B drops: Vosol is not recommended for patients <3 years; No aminoglycosides with non-intact TM (ie rupt. Eardrum)

Question 7

Otitis Externa Third Line

Answer 7

antifungal drops: consider if a patient fails to respond to initial topical antibiotic therapy; systemic antipseudomonal or antistaphylococcal agent: consider if ear canal obstruction cannot be relieved or if infection extends beyond the ear canal.

Question 8

Otitis Externa Floxacin

Answer 8

Dosage:
children 1 to 12 years: 5 drops into ear canal bid for 10 days; children >12 years
adults: 10 drops bid for 10 days maximum
Adverse events: pruritus, site reaction, dizziness, earache, vertigo, taste perversion, paresthesia, rash
Contraindications: patients <1 year, perforated eardrum, caution in pregnancy (category C drug) and in breast-feeding patients

Question 9

Otitis Externa polymyxin B sulfate, neomycin, and hydrocortisone (Cortisporin Otic)

Answer 9

Dosage:
children: 3 drops into ear canal three to four times daily for maximum of 10 days
adults: 4 drops into ear canal three to four times daily for maximum of 10 days
Adverse events: superinfection, contact dermatitis, ototoxicity with prolonged use
Contraindications: herpes simplex, fungal, tubercular, or viral otic infections, perforated eardrum, caution in pregnancy (category C drug) and in breast-feeding patients

Question 10

Acute otitis externa (swimmer’s ear) prevention

Answer 10

Topical acid or alcohol solution (Domeboro otic, Burow’s otic, VoSol) - into the ear QID if the TM is intact-reduces inflammation and have antibacterial/antifungal properties.

Question 11

Chronic otitis externa

Answer 11

Can be inflammatory or infectious (psoriasis, eczema, seborrhea, infected sinus tracts, cysts, fungi)
Mineral oil daily
Steroid cream or lotion
Selenium sulfide shampoo