Otitis Externa Flashcards
What is otitis externa?
Otitis externa is a common reason for primary care attendance in the UK.
What are the causes of otitis externa?
Causes include infection (bacterial: Staphylococcus aureus, Pseudomonas aeruginosa; fungal), seborrhoeic dermatitis, contact dermatitis (allergic and irritant), and recent swimming.
What are the features of otitis externa?
Features include ear pain, itch, discharge, and otoscopy findings of a red, swollen, or eczematous canal.
What is the recommended initial management of otitis externa?
The initial management includes topical antibiotic or a combined topical antibiotic with a steroid. If the tympanic membrane is perforated, aminoglycosides are traditionally not used.
What should be considered if there is canal debris in otitis externa?
Consider removal of the canal debris.
What is done if the canal is extensively swollen in otitis externa?
An ear wick is sometimes inserted.
What are second-line options for managing otitis externa?
Second-line options include considering contact dermatitis secondary to neomycin, oral antibiotics (flucloxacillin) if the infection is spreading, taking a swab inside the ear canal, and empirical use of an antifungal agent.
What should be done if a patient fails to respond to topical antibiotics?
The patient should be referred to ENT.
Who is more commonly affected by malignant otitis externa?
Malignant otitis externa is more common in elderly diabetics.
What characterizes malignant otitis externa?
It involves extension of infection into the bony ear canal and the soft tissues deep to the bony canal.
What treatment may be required for malignant otitis externa?
Intravenous antibiotics may be required.
What is a point of contention regarding aminoglycosides in otitis externa?
Many ENT doctors disagree with the traditional avoidance of aminoglycosides in perforated tympanic membranes, feeling that concerns about ototoxicity are unfounded.
What is malignant otitis externa?
An uncommon type of otitis externa found in immunocompromised individuals, primarily diabetics.
What is the most common cause of malignant otitis externa?
Pseudomonas aeruginosa.
How does malignant otitis externa progress?
Infection starts in the soft tissues of the external auditory meatus and progresses to the bony ear canal and temporal bone osteomyelitis.
