Otitis Externa

Question 1

What are the causes of otitis externa?

Answer 1

• Infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal
• Seborrhoeic dermatitis
• Contact dermatitis (allergic and irritant)

Question 2

What is the recommended initial management of otitis externa?

Answer 2

• Topical antibiotic or a combined topical antibiotic with steroid
• If the tympanic membrane is perforated aminoglycosides are traditionally not used (But many ENT doctors disagree with this & use them)
• If there is canal debris then consider removal
• If the canal is extensively swollen then an ear wick is sometimes inserted

Question 3

What are some second line treatments for otitis externa?

Answer 3

• Consider contact dermatitis secondary to neomycin
• Oral antibiotics if the infection is spreading
• Taking a swab inside the ear canal
• Empirical use of an antifungal agent

Question 4

In what populations is malignant otitis externa present?

How does it present?

And what is the treatment?

Answer 4

Elderly diabetics

Extension of infection into the bony ear canal and the soft tissues deep in the boney canal.

IV Abx.

Question 5

NICE suggests that inflammation is more likely to be severe if there is?

Answer 5

• A red, oedematous ear canal that is narrowed and obscured by debris.
• Conductive hearing loss
• Discharge
• Regional lymphadenopathy
• Cellulitis spreading beyond the ear
• Fever

Question 6

What topical antibiotic is used for mild cases?

Answer 6

Acetic acid 2% spray

Question 7

If the infection or inflammation is more severe what is recommended?

Answer 7

Topical antibiotics +/- steroids

Sofradex or Gentisone HC

Question 8

When should swabs be taken?

Answer 8

Only if there is no response to an initial course or if the infection is recurrent.

Question 9

What advise should you give patients?

Answer 9

Use simple analgesia

Avoid getting water into the ear until the infection has resolved.