Otitis externa
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
See Also
ENT: Otitis media
Source
UpToDate