Otitis externa: Difference between revisions

Revision as of 23:41, 1 March 2011

Background

Microbiology
Pseudomonas, staph, strep, anerobes
Fungal infection 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-pain on gentle traction of the external ear structures

Differential Diagnosis

Necrotizing otitis externa
Spread of infection to soft tissue, cartilage, bone of temporal region
Most common in elderly, diabetic patients
Granulation tissue often seen in the ear canal floor
Prompt referral to ENT; treat with anti-pseudomonal agents
Otomycosis
Pts complain more of itching than pain
Characteristic apperance 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
Topical antibiotic therapy
Floxin Otic: 5 drops in affected ear BID x 7 days
Cipro HC Otic: 3 drops in affected ear BID x 7 days
Contains hydrocortisone = faster healing
Cortisporin Otic suspension: 4 drops TID x 7 days
Avoid in pts with perforated TM
Analgesia
NSAIDs
Avoiding promoting factors
Keep ear canal dry
Abstain from water sports for 7-10 days
Follow-up
1-2 weeks for pts with moderate disease

Source

UpToDate

Authors:

@@ Line 2: / Line 2: @@
-Organisms: Pseudomonas, Staph, Strep. Sometimes fungi.
+* Microbiology
+* Pseudomonas, staph, strep, anerobes
-Risk Factors: regularly exposed to water (eg. swimmers, divers) or Q-tips
+* Fungal infection may present after Abx tx
+* Risk Factors: Swimming, excessive Q-tip use
 == ==
@@ Line 12: / Line 12: @@
--pain on gentle traction of the external ear structures
+* Otalgia
+* Elicited by tragal pressure, pulling the auricle superiorly
+* Pruritis
+* Discharge
+* Hearing loss-pain on gentle traction of the external ear structures
 == ==
-==Work-Up==
+==Differential Diagnosis==
-Clinical ==DDx==
-Otitis media
-Malignant otitis externa
-    -deeper invasion into adjacent structures
-     -mostly in immunocompromised patients
+* Necrotizing otitis externa
+* Spread of infection to soft tissue, cartilage, bone of temporal region
+* Most common in elderly, diabetic patients
+* Granulation tissue often seen in the ear canal floor
+* Prompt referral to ENT; treat with anti-pseudomonal agents
+* Otomycosis
+* Pts complain more of itching than pain
+* Characteristic apperance 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
 == ==
@@ Line 37: / Line 43: @@
-) Ciprofloxacin 0.3%/dexamethasone 0.1% otic suspension     -(dexamethasone improves treatment success)
+* Clean the ear canal
+* Cerumen wire loop or cotton swab
-) Fungal infection
+* 1:1 dilution of 3% hydrogen peroxide if TM is visible and intact
+* Topical antibiotic therapy
-     -mild: acetic acid solution
+* Floxin Otic: 5 drops in affected ear BID x 7 days
+* Cipro HC Otic: 3 drops in affected ear BID x 7 days
-     -more severe: topical antifungal (e.g. 1% clotrimazole)
+* Contains hydrocortisone = faster healing
+* Cortisporin Otic suspension: 4 drops TID x 7 days
+* Avoid in pts with perforated TM
+* Analgesia
-*if concern for perforated tympanic membrane, avoid using otic aminoglycoside solution (risk of ototoxicity). In this setting, suspension drops are safer to use.
+* NSAIDs
+* Avoiding promoting factors
+* Keep ear canal dry
+* Abstain from water sports for 7-10 days
+* Follow-up
+* 1-2 weeks for pts with moderate disease
+== ==
- ==Disposition==
-Outpatient
 ==See Also==
@@ Line 66: / Line 72: @@
-KajiQuestions
+UpToDate