Otitis Externa

Question 1

Which organism is most commonly implicated in otitis externa?

Answer 1

Pseudomonas

Question 2

What is this a presentation of?

Discharge, swollen canal, erythematous itch, pain, and tragal and pinna tenderness.

Answer 2

Otitis externa

Question 3

What is the commonest cause of otitis externa?

Answer 3

Excess canal moisture

Question 4

What is the management for otitis externa in mild/moderate diameter of the external auditory canal?

Answer 4

Clean external auditory canal

Question 5

What is the management for otitis externa in moderate narrowed external auditory canal?

Answer 5

1. Swab for MC&S
2. Clean external auditory canal - microsuction
3. Topical ciprofloxacin +/- topical steroid drops for 7 days (avoid aminoglycosides)
4. Oral antibiotics if pinna cellulitis and infection spreading
5. ENT referral if failure to respond to topical antibiotics

Question 6

What is the management for otitis externa in severe occluded external auditory canal?

Answer 6

1. Refer to ENT

2. Thin ear wick inserted containing aluminium acetate to open up external auditory canal.

Question 7

What can persistent unilateral otitis externa progress to in elderly/immunocompromised/diabetes mellitus patients?

Answer 7

Malignant/necrotising otitis externa - temporal bone destruction (life threatening)

Question 8

What are the complications of otitis externa and how are they investigated and treated?

Answer 8

1. Severe otalgia, cranial nerve palsies - CT scan, surgical debridement, IV Abx
2. Pinna cellulitis - admission for IV Abx