Otitis externa

Background

Microbiology

1. Staph/Strep
2. Pseudomonas
3. Enterobacter
4. Proteus
5. Fungus
   1. Aspergillus, candida (may present after abx tx)

Risk Factors

1. Swimming
2. Excessive Q-tip use

Diagnosis

1. Otalgia
   1. Elicited by tragal pressure, pulling the auricle superiorly
2. Pruritis
3. Discharge
4. Hearing loss

Differential Diagnosis

1. Malignant Otitis Externa
2. Otomycosis
   1. Pts complain more of itching than pain
   2. Characteristic appearance on exam; like mold growing on spoiled food
   3. Treatment
      1. Cleaning of ear canal
      2. Topical antifungal
3. Contact Dermatitis
   1. Chronic suppurative otitis media
   2. Ear canal findings are usually mild compared with bacterial external otitis

Treatment

1. Clean the ear canal
   1. Cerumen wire loop or cotton swab
   2. 1:1 dilution of 3% hydrogen peroxide if TM is visible and intact
2. Antibiotics
   1. Floxin Otic: 5 drops in affected ear BID x 7 days
      1. Safe with perforations
   2. Cipro HC Otic: 3 drops in affected ear BID x 7 days
      1. Contains hydrocortisone = faster healing
      2. Not safe with perforation
3. Cortisporin Otic (neomycin/polymixin B/hydrocortisone)
   1. 4 gtt in ear ITD-QID x 7dy
   2. Use suspension (NOT solution) if possiblity of perforation
4. Analgesia
   1. NSAIDs
5. Avoiding promoting factors
   1. Keep ear canal dry
   2. Abstain from water sports for 7-10 days

Disposition

• F/u in 1-2wks for pts with moderate disease

See Also

• Otitis Media (Peds)
• Malignant Otitis Externa

Source

• UpToDate
• Tintinalli