Otitis externa: Difference between revisions
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==Background==
==Background==
[[File:Gray907.png|thumb|Ear anatomy]]
===Microbiology===
===Microbiology===
#Staph/Strep
*[[Pseudomonas]] (most common)
#Pseudomonas
*[[Staph]]/[[Strep]]
#Enterobacter
*[[Enterobacter]]
#Proteus
*[[Proteus mirabilis]]
#Fungus
*Fungus (may present after antibiotic treatment)
##Aspergillus, candida (may present after abx tx)
**[[Aspergillus]]
**[[Candida]]


===Risk Factors===
===Risk Factors===
#Swimming
*Swimming
#Excessive Q-tip use
*Excessive Q-tip use


==Diagnosis==
==Clinical Features==
#Otalgia
[[File:Otitis externa mild.jpg|thumb|Mild otitis externa]]
##Elicited by tragal pressure, pulling the auricle superiorly
[[File:OtitisExterna severe.jpg|thumb|Severe otitis externa]]
#Pruritis
;Rapid onset (generally within 48 hours) in the past 3 weeks, '''AND'''.<ref name="CPGENT2014">Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 [http://www.aepap.org/sites/default/files/otitis_externa_guia2014-rosenfeld-161-8_0.pdf PDF]</ref>
#Discharge
*''Symptoms''
#[[Hearing loss]]
**[[earache|otalgia]] (often severe)
**itching, or fullness, WITH OR WITHOUT
**[[hearing loss]] or jaw pain AND...
*''Signs''
**tenderness of the tragus, pinna, or both OR
**diffuse ear canal edema, erythema, or both WITH OR WITHOUT
**otorrhea
**regional [[lymphadenitis]]
**tympanic membrane erythema, or
**[[cellulitis]] of the pinna and adjacent skin


==Differential Diagnosis==
==Differential Diagnosis==
#[[Malignant Otitis Externa]]
{{Ear DDX}}
#Otomycosis
 
##Pts complain more of itching than pain
==Evaluation==
##Characteristic appearance on exam; like mold growing on spoiled food
*Normally clinical
##Treatment
 
###Cleaning of ear canal
==Management==
###Topical antifungal
===Hygiene===
#Contact Dermatitis
*Clean the ear canal ([[EBQ:Evidence Levels|Grade C]])
##Chronic suppurative otitis media
**Cerumen wire loop or cotton swab usually works best
##Ear canal findings are usually mild compared with bacterial external otitis
**1:1 dilution of 3% hydrogen peroxide if tympanic membrane is visible and intact
#[[Ramsay Hunt syndrome]]
**Acetic acid wash for debridement of dead skin
**'''Place a wick if the ear canal is fully obstructed'''
 
===[[Analgesia]]===
*[[NSAIDs]]
 
===Prevention===
*Keep ear canal dry
**Abstain from water sports for 7-10 days


==Treatment==
#Clean the ear canal
##Cerumen wire loop or cotton swab
##1:1 dilution of 3% hydrogen peroxide if TM is visible and intact
#Analgesia
##NSAIDs
#Avoiding promoting factors
##Keep ear canal dry
##Abstain from water sports for 7-10 days
===Antibiotics===
===Antibiotics===
{{Otitis Externa Antibiotics}}
{{Otitis Externa Antibiotics}}
*Immunosuppressed (poorly controlled diabetes, chemotherapy, chronic high dose corticosteroid use, immunosuppressive drugs, neutropenia) give systemic antibiotic ([[ciprofloxacin]] or [[ofloxacin]]) <ref> Santos F, Selesnick SH, Gurnstein E.  Diseases of the External Ear. In:Current Diagnosis and Treatment in Otolaryngology: Head and Neck Surgery, Lalwani AK (Ed), Lange Medical Books/McGraw-Hill, New York 2004. </ref>


==Disposition==
==Disposition==
*F/u in 1-2wks for pts with moderate disease  
*Follow up in 1-2wks for patients with moderate disease


==See Also==
==See Also==
Line 51: Line 62:
*[[Malignant Otitis Externa]]
*[[Malignant Otitis Externa]]


==Source==
==External Links==
*UpToDate
*[https://youtu.be/8JXUGTkIC1Q Ear Wick Placement for Otitis Externa]
*Tintinalli
*[http://www.entnet.org/sites/default/files/AOEGuidelinePLSFinal.pdf PLAIN LANGUAGE SUMMARY: Acute Otitis Externa (Swimmer’s Ear)]
 
==References==
<references/>


[[Category:ENT]]
[[Category:ENT]]
[[Category:ID]]
[[Category:ID]]

Revision as of 22:10, 30 September 2019

Background

Ear anatomy

Microbiology

Risk Factors

  • Swimming
  • Excessive Q-tip use

Clinical Features

Mild otitis externa
Severe otitis externa
Rapid onset (generally within 48 hours) in the past 3 weeks, AND.[1]
  • Symptoms
  • Signs
    • tenderness of the tragus, pinna, or both OR
    • diffuse ear canal edema, erythema, or both WITH OR WITHOUT
    • otorrhea
    • regional lymphadenitis
    • tympanic membrane erythema, or
    • cellulitis of the pinna and adjacent skin

Differential Diagnosis

Ear Diagnoses

External

Internal

Inner/vestibular

Evaluation

  • Normally clinical

Management

Hygiene

  • Clean the ear canal (Grade C)
    • Cerumen wire loop or cotton swab usually works best
    • 1:1 dilution of 3% hydrogen peroxide if tympanic membrane is visible and intact
    • Acetic acid wash for debridement of dead skin
    • Place a wick if the ear canal is fully obstructed

Analgesia

Prevention

  • Keep ear canal dry
    • Abstain from water sports for 7-10 days

Antibiotics

  1. Ofloxacin (Floxin otic): 5 drops in affected ear BID x 7 days[1]
    • Safe with perforations
  2. Ciprofloxacin-hydrocortisone (Cipro HC): 3 drops in affected ear BID x 7 days
    • Contains hydrocortisone to promote faster healing
    • Not recommended for perforation since non-sterile preparation
  3. Ciprofloxacin-dexamthasone (Ciprodex): 4 drops in affected ear BID x 7 days
    • Similar to Cipro HC but safe for perforations
    • Often more expensive
  4. Cortisporin otic (neomycin/polymixin B/hydrocortisone): 4 drops in ear TID-QID x 7days
    • Use suspension (NOT solution) if possibility of perforation
    • Animal studies suggest possible toxicity from the neomycin although rigorous data is lacking[2]
  • Immunosuppressed (poorly controlled diabetes, chemotherapy, chronic high dose corticosteroid use, immunosuppressive drugs, neutropenia) give systemic antibiotic (ciprofloxacin or ofloxacin) [3]

Disposition

  • Follow up in 1-2wks for patients with moderate disease

See Also

External Links

References

  1. ↑ 1.0 1.1 Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 PDF
  2. ↑ Wright, C. et al. Ototoxicity of neomycin and polymyxin B following middle ear application in the chinchilla and baboon. Am J Otol. 1987 Nov;8(6):495-9.
  3. ↑ Santos F, Selesnick SH, Gurnstein E. Diseases of the External Ear. In:Current Diagnosis and Treatment in Otolaryngology: Head and Neck Surgery, Lalwani AK (Ed), Lange Medical Books/McGraw-Hill, New York 2004.
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