Otitis Externa

Question 1

What are the causes?

Answer 1

Acute
- infection most commonly pseudomonas and staph.aureus

Chronic (>3 month)
- commonly caused by fungal infection e.g. aspergillus/candidiasis

Complication of AOM
Seborrhoeic dermatitis
Contact dermatitis

Question 2

What are clinical features?

Answer 2

Acute onset pain or pruritis
Ear discharge
Chronic OE

Otoscopy- erythema of external auditory canal +/- oedema, discharge or debris

Question 3

What is the management?

Answer 3

Acute
- aural toilet- swabbing to remove debris
1) Topical abx +/- topical steroids for 1-2 weeks
- do not use aminoglycosides if perforated TM
Consider PO abx if immunocompromised, severe OE or spreading infection

Chronic OE
- Fungal infection- topical antifungal e.g. clotrimazole +/- steroid
- if not infective trial steroids

if not responding to treatment then ENT referral

Question 4

What is Malignant OE?

Answer 4

Severe complication where infection spreads to temporal bone causing acute osteomyelitis

Risk factors
- immunocompromised
-poorly controlled diabetes

Question 5

What are clinical features of malignant OE?

Answer 5

Severe pain in affected ear
Smelly purulent discharge
Systemic upset- fever/tachycardia

Conductive hearing loss
Facial nerve palsy on affected side
Otoscopy- granulation tissue within external auditory meatus, exposed bone

Question 6

What is the management of malignant otitis externa?

Answer 6

IV antibiotics (normal ciprofloxacin for 6 weeks(
Admit to hospital