Otitis externa: Difference between revisions
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==Background== | ==Background== | ||
===Microbiology=== | ===Microbiology=== | ||
#Staph/Strep | |||
#Pseudomonas | #Pseudomonas | ||
# | #Enterobacter | ||
# | #Proteus | ||
# | #Fungus | ||
# | ##Aspergillus, candida (may present after abx tx) | ||
===Risk Factors=== | ===Risk Factors=== | ||
| Line 19: | Line 20: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
# | #[[Malignant Otitis Externa]] | ||
#Otomycosis | #Otomycosis | ||
##Pts complain more of itching than pain | ##Pts complain more of itching than pain | ||
| Line 31: | Line 27: | ||
###Cleaning of ear canal | ###Cleaning of ear canal | ||
###Topical antifungal | ###Topical antifungal | ||
#Contact | #Contact Dermatitis | ||
#Chronic suppurative otitis media | ##Chronic suppurative otitis media | ||
##Ear canal findings are usually mild compared with bacterial external otitis | ##Ear canal findings are usually mild compared with bacterial external otitis | ||
| Line 39: | Line 35: | ||
##Cerumen wire loop or cotton swab | ##Cerumen wire loop or cotton swab | ||
##1:1 dilution of 3% hydrogen peroxide if TM is visible and intact | ##1:1 dilution of 3% hydrogen peroxide if TM is visible and intact | ||
# | #Antibiotics | ||
##Floxin Otic: 5 drops in affected ear BID x 7 days | ##Floxin Otic: 5 drops in affected ear BID x 7 days | ||
###Safe with perforations | |||
##Cipro HC Otic: 3 drops in affected ear BID x 7 days | ##Cipro HC Otic: 3 drops in affected ear BID x 7 days | ||
###Contains hydrocortisone = faster healing | ###Contains hydrocortisone = faster healing | ||
## | ###Not safe with perforation | ||
# | |||
#Analgesia | #Analgesia | ||
##NSAIDs | ##NSAIDs | ||
| Line 50: | Line 46: | ||
##Keep ear canal dry | ##Keep ear canal dry | ||
##Abstain from water sports for 7-10 days | ##Abstain from water sports for 7-10 days | ||
==Disposition== | |||
*F/u in 1-2wks for pts with moderate disease | |||
==See Also== | ==See Also== | ||
[[Otitis Media (Peds)]] | *[[Otitis Media (Peds)]] | ||
*[[Malignant Otitis Externa]] | |||
==Source== | ==Source== | ||
UpToDate | *UpToDate | ||
*Tintinalli | |||
Tintinalli | |||
[[Category:ENT]] | [[Category:ENT]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 01:33, 4 November 2011
Background
Microbiology
- Staph/Strep
- Pseudomonas
- Enterobacter
- Proteus
- Fungus
- Aspergillus, candida (may present after abx tx)
Risk Factors
- Swimming
- Excessive Q-tip use
Diagnosis
- Otalgia
- Elicited by tragal pressure, pulling the auricle superiorly
- Pruritis
- Discharge
- Hearing loss
Differential Diagnosis
- Malignant Otitis Externa
- Otomycosis
- Pts complain more of itching than pain
- Characteristic appearance on exam; like mold growing on spoiled food
- Treatment
- Cleaning of ear canal
- Topical antifungal
- Contact Dermatitis
- Chronic suppurative otitis media
- Ear canal findings are usually mild compared with bacterial external otitis
Treatment
- Clean the ear canal
- Cerumen wire loop or cotton swab
- 1:1 dilution of 3% hydrogen peroxide if TM is visible and intact
- Antibiotics
- Floxin Otic: 5 drops in affected ear BID x 7 days
- Safe with perforations
- Cipro HC Otic: 3 drops in affected ear BID x 7 days
- Contains hydrocortisone = faster healing
- Not safe with perforation
- Floxin Otic: 5 drops in affected ear BID x 7 days
- Analgesia
- NSAIDs
- Avoiding promoting factors
- Keep ear canal dry
- Abstain from water sports for 7-10 days
Disposition
- F/u in 1-2wks for pts with moderate disease
See Also
Source
- UpToDate
- Tintinalli