Otitis externa

Question 1

What are the symptoms of otitis externa?

Answer 1

Pain (otalgia)
Swelling of external ear canal
Discharge
Erythematous external ear canal
Itching
Conductive hearing loss

Question 2

What pathogens can cause otitis externa?

Answer 2

Staph. aureus (most common cause)
Pseudomonas aeruginosa (common cause of abx resistant infection)
Aspergillus
Seborrhoeic dermatitis
Contact dermatitis (allergic and irritant)

Question 3

What is the management for otitis externa?

Answer 3

Analgesia
Keep ear dry
If systemic illness, give IV abx

1st line - Topical abx drop with a steroid:
Sofradex (framycetin, dexamethasone and gramicidin)
Gentisone (Gentamycine and hydrocortisone)
Otomize (dexamethasone, neomycin and acetic acid)

If patient unwell, have complications, or not responding to abx then refer to ENT

If otitis externa with pinna perichondritis:
Topical drops with aural wick
Otowick kept in ear for 48hrs
Gentle micro-suction to remove debris

Question 4

What serious complication can occur in otitis externa?

Answer 4

Malignant otitis externa:

Usually in diabetics or immunosuppressed patients

Question 5

What are the features of malignant otitis externa?

Answer 5

Severe, deep otalgia
Temporal headaches
Purulent discharge
May have dysphagia, dysphonia and facial nerve dysfunction

Question 6

How is malignant otitis externa treated?

Answer 6

IV fluoroquinolone