Otitis Externa Flashcards
Otitis externa or swimmers ear
Inflammation of external ear canal
Causes
Immersion of head underwater
Trauma from improper cleaning
Wearing hearing aids
Constant moisture from sweat
Risk factors
Anatomic abnormalities
Canal obstruction
Dermatologic conditions
Water in ear canal
Common organisms
Pseudomonas aeruginosa
Staphylococcus aureus
Aspergillus fungus
Candida
Prevention
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
Treatment
Topical antimicrobial with or without topical corticosteroids
When is systemic antimicrobial recommended
When infection has spread beyond ear canal or in other special circumstances
First line
Amino-glycoside: neomycin/ polymixinb / hydrocortisone
When is first line appropriate
No concern for aminoglycoside hypersensitivity
Intact tympanic membrane
Frequency of first line dosing
4 drops TID or QID
Second line
Ciprofloxacin/dexmethasone
Or
Ofloxacin
When is second line appropriate
Aminoglycoside hypersensitivity
Tympanic membrane not intact
Second line dosing frequency
Ciprofloxacin/dexmethasone: 3 drops BID
Ofloxacin; 10 drops once daily or BID
First line ADR
Ear stinging/burning
Second line ADR
Ciprofloxacin: Headache
Ofloxacin: application site reaction, puritic, dysgeusia
Adjunctive therapy options
Corticosteroid when indicated
Analgesia: NSAID or acetaminophen
Medication administration
◼ 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
Adults
Pull Top ear part upward
Children
Pull bottom ear part downwards and backwards
What is chronic otitis external
> 3 months
Signs of chronic OE
Ear canal erythematous with itching as a predominant Symptoms
Chronic OE treatment
Treat underlying causes/conditions:
◼Allergies
◼Inflammatory dermatologic conditions
◼Treat by removing offending agents and using topical/systemic
corticosteroids
What type of otitis externa is common in immunocompromised or diabetic patient
Malignant OE
Malignant OE
Invasive infection of cartilage and bone of the canal and
external ear
Malignant Of symptoms
facial nerve palsy and pain
Diagnosis of malignant OE
CT/MRI recommended to confirm diagnosis
Malignant OE treatment
aggressive debridement
systemic antibiotics targeting P aeruginosa
