Otitis Externa

Question 1

Otitis externa or swimmers ear

Answer 1

Inflammation of external ear canal

Question 2

Causes

Answer 2

Immersion of head underwater

Trauma from improper cleaning

Wearing hearing aids

Constant moisture from sweat

Question 3

Risk factors

Answer 3

Anatomic abnormalities

Canal obstruction

Dermatologic conditions

Water in ear canal

Question 4

Common organisms

Answer 4

Pseudomonas aeruginosa

Staphylococcus aureus

Aspergillus fungus

Candida

Question 5

Prevention

Answer 5

Soft, malleable ear plugs while swimming

Removing water from ears after swimming

Avoiding cotton swab

Alcohol or acidic drops during or after at risk activities

Question 6

Treatment

Answer 6

Topical antimicrobial with or without topical corticosteroids

Question 7

When is systemic antimicrobial recommended

Answer 7

When infection has spread beyond ear canal or in other special circumstances

Question 8

First line

Answer 8

Amino-glycoside: neomycin/ polymixinb / hydrocortisone

Question 9

When is first line appropriate

Answer 9

No concern for aminoglycoside hypersensitivity

Intact tympanic membrane

Question 10

Frequency of first line dosing

Answer 10

4 drops TID or QID

Question 11

Second line

Answer 11

Ciprofloxacin/dexmethasone

Or

Ofloxacin

Question 12

When is second line appropriate

Answer 12

Aminoglycoside hypersensitivity

Tympanic membrane not intact

Question 13

Second line dosing frequency

Answer 13

Ciprofloxacin/dexmethasone: 3 drops BID

Ofloxacin; 10 drops once daily or BID

Question 14

First line ADR

Answer 14

Ear stinging/burning

Question 15

Second line ADR

Answer 15

Ciprofloxacin: Headache

Ofloxacin: application site reaction, puritic, dysgeusia

Question 16

Adjunctive therapy options

Answer 16

Corticosteroid when indicated

Analgesia: NSAID or acetaminophen

Question 17

Medication administration

Answer 17

◼ Lie down on side with affected side facing upwards

◼ Instill preparation along the ear canal

◼ Gently move the pinna to remove air pockets

◼ Remain in position for 3-5 minutes

◼ Do not occlude ear canal, instead leave open to dry

Question 18

Adults

Answer 18

Pull Top ear part upward

Question 19

Children

Answer 19

Pull bottom ear part downwards and backwards

Question 20

What is chronic otitis external

Answer 20

> 3 months

Question 21

Signs of chronic OE

Answer 21

Ear canal erythematous with itching as a predominant Symptoms

Question 22

Chronic OE treatment

Answer 22

Treat underlying causes/conditions:

◼Allergies

◼Inflammatory dermatologic conditions

◼Treat by removing offending agents and using topical/systemic
corticosteroids

Question 23

What type of otitis externa is common in immunocompromised or diabetic patient

Answer 23

Malignant OE

Question 24

Malignant OE

Answer 24

Invasive infection of cartilage and bone of the canal and

external ear

Question 25

Malignant Of symptoms

Answer 25

facial nerve palsy and pain

Question 26

Diagnosis of malignant OE

Answer 26

CT/MRI recommended to confirm diagnosis

Question 27

Malignant OE treatment

Answer 27

aggressive debridement

systemic antibiotics targeting P aeruginosa