Otitis externa: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gray907.png|thumb|Ear anatomy]] | |||
===Microbiology=== | ===Microbiology=== | ||
*[[Pseudomonas]] (most common) | |||
*[[Staph]]/[[Strep]] | *[[Staph]]/[[Strep]] | ||
*[[Enterobacter]] | *[[Enterobacter]] | ||
*[[Proteus mirabilis]] | *[[Proteus mirabilis]] | ||
*Fungus | *Fungus (may present after antibiotic treatment) | ||
**[[Aspergillus]] | **[[Aspergillus]] | ||
**[[Candida]] | |||
===Risk Factors=== | ===Risk Factors=== | ||
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*Excessive Q-tip use | *Excessive Q-tip use | ||
== | ==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== | ||
*[[ | {{Ear DDX}} | ||
* | |||
** | ==Evaluation== | ||
** | *Normally clinical | ||
** | |||
==Management== | |||
===Hygiene=== | |||
*Clean the ear canal ([[EBQ:Evidence Levels|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]]=== | |||
*[[NSAIDs]] | |||
== | ===Prevention=== | ||
*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== | ||
* | *Follow up in 1-2wks for patients with moderate disease | ||
==See Also== | ==See Also== | ||
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*[[Malignant Otitis Externa]] | *[[Malignant Otitis Externa]] | ||
== | ==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
Microbiology
- Pseudomonas (most common)
- Staph/Strep
- Enterobacter
- Proteus mirabilis
- Fungus (may present after antibiotic treatment)
Risk Factors
- Swimming
- Excessive Q-tip use
Clinical Features
- Rapid onset (generally within 48 hours) in the past 3 weeks, AND.[1]
- Symptoms
- 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
Ear Diagnoses
External
- Auricular hematoma
- Auricular perichondritis
- Cholesteatoma
- Contact dermatitis
- Ear foreign body
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Malignant otitis externa
- Otitis externa
- Otomycosis
- Tympanic membrane rupture
Internal
- Acute otitis media
- Chronic otitis media
- Mastoiditis
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
- Ofloxacin (Floxin otic): 5 drops in affected ear BID x 7 days[1]
- Safe with perforations
- 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
- Ciprofloxacin-dexamthasone (Ciprodex): 4 drops in affected ear BID x 7 days
- Similar to Cipro HC but safe for perforations
- Often more expensive
- 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
- ↑ 1.0 1.1 Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 PDF
- ↑ 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.
- ↑ 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.