Otitis Externa

Question 1

What are the features of Otitis externa?

Answer 1

Otalgia
Minimal discharge
Itch
Pain

Question 2

What is the pain from otitis externa due to?

Answer 2

acute inflammation of the skin of the external auditory meatus.

Question 3

When is hearing affected in otitis externia?

Answer 3

if the meatus becomes blocked by swelling or discharge

Question 4

What is the causative organism in otitis externa?

Answer 4

Pseudomonas spp. and staphylococcus aureus.

Question 5

What is the management of otitis externa?

Answer 5

Treatment varies depending on the severity of the otitis externa with systemic antibiotics being reserved for patients with fever or lymphadenitis.
Unblocked otitis externa- Can be treated with topical drops including combined antibiotic/steroid drops (e.g. Gentamix), acetic acid and other preparations.

Blocked severe otitis externa- Where the meatus is completely occluded and there is significant swelling of the external meatus may be treated using a strip of ribbon gauze known as “Pope” wicks which can be used for the application of topical antibiotics (classically gentamicin) enabling deeper penetration.

Question 6

What is advised to patient with mild otitis externa not yet blocked?

Answer 6

keep the ear dry for the next 7-10 days.

Question 7

Who is at caution if they have otitis externa? Why?

Answer 7

Caution should be used in patients who are immunosuppressed (diabetes mellitus/elderly/HIV positive) due to increased risk of developing malignant otitis externa.

Question 8

What are the indications to consider oral antibiotics in otitis externa?

Answer 8

Cellulitis extending beyond the external ear canal
When the ear canal is occluded by swelling and debris, and a wick cannot be inserted
People with diabetes or compromised immunity, and severe infection or high risk of severe infection, for example with Pseudomonas aeruginosa

Question 9

What should be advised for patients with otitis externa?

Answer 9

Water precautions