Otitis externa

Question 1

causes

Answer 1

infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal

seborrhoeic dermatitis

contact dermatitis (allergic and irritant)

recent swimming is a common trigger of otitis externa

Question 2

symptoms

Answer 2

ear pain,

itch,

discharge

Question 3

what is seen on otoscope

Answer 3

red, swollen, or eczematous canal

Question 4

initial Mx

Answer 4

topical antibiotic or a combined topical antibiotic with a steroid

if the tympanic membrane is perforated aminoglycosides are traditionally not used*

if there is canal debris then consider removal

if the canal is extensively swollen then an ear wick is sometimes inserted

Question 5

second line mx options

Answer 5

consider contact dermatitis secondary to neomycin

oral antibiotics (flucloxacillin) if the infection is spreading

taking a swab inside the ear canal

empirical use of an antifungal agent

Question 6

when should a patient be reffered to ENT

Answer 6

If a patient fails to respond to topical antibiotics

Question 7

who is malignant otitis externally common in and why and what is the Mx?

Answer 7

elderly diabetics

there is extension of infection into the bony ear canal and the soft tissues deep to the bony canal.

Intravenous antibiotics may be required.