Otitis externa: Difference between revisions

No edit summary
(32 intermediate revisions by 8 users not shown)
Line 1: Line 1:
==Background==
==Background==
[[File:Gray907.png|thumb|Ear anatomy]]
===Microbiology===
===Microbiology===
*[[Pseudomonas]] (most common)
*[[Staph]]/[[Strep]]
*[[Staph]]/[[Strep]]
*[[Pseudomonas]]
*[[Enterobacter]]
*[[Enterobacter]]
*[[Proteus mirabilis]]
*[[Proteus mirabilis]]
*Fungus
*Fungus (may present after antibiotic treatment)
**[[Aspergillus]], [[candida]] (may present after antibiotic treatment)
**[[Aspergillus]]
**[[Candida]]


===Risk Factors===
===Risk Factors===
Line 12: Line 14:
*Excessive Q-tip use
*Excessive Q-tip use


==Diagnosis==
==Clinical Features==
;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>
[[File:Otitis externa mild.jpg|thumb|Mild otitis externa]]
* ''Symptoms''  
[[File:OtitisExterna severe.jpg|thumb|Severe otitis externa]]
**otalgia (often severe)
;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>
*''Symptoms''  
**[[earache|otalgia]] (often severe)
**itching, or fullness, WITH OR WITHOUT  
**itching, or fullness, WITH OR WITHOUT  
**hearing loss or jaw pain AND...
**[[hearing loss]] or jaw pain AND...
* ''Signs''
*''Signs''
**tenderness of the tragus, pinna, or both OR  
**tenderness of the tragus, pinna, or both OR  
**diffuse ear canal edema, erythema, or both WITH OR WITHOUT  
**diffuse ear canal edema, erythema, or both WITH OR WITHOUT  
**otorrhea
**otorrhea
**regional lymphadenitis
**regional [[lymphadenitis]]
**tympanic membrane erythema, or  
**tympanic membrane erythema, or  
**cellulitis of the pinna and adjacent skin
**[[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]]


==Treatment==
===Prevention===
*Clean the ear canal
*Keep ear canal dry
**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
**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 58: Line 62:
*[[Malignant Otitis Externa]]
*[[Malignant Otitis Externa]]


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