Otitis externa

Background

Microbiology

1. Staph/Strep
2. Pseudomonas
3. Enterobacter
4. Proteus
5. Fungus
   1. Aspergillus, candida (may present after abx tx)

Risk Factors

1. Swimming
2. Excessive Q-tip use

Diagnosis

1. Otalgia
   1. Elicited by tragal pressure, pulling the auricle superiorly
2. Pruritis
3. Discharge
4. Hearing loss

Differential Diagnosis

1. Malignant Otitis Externa
2. Otomycosis
   1. Pts complain more of itching than pain
   2. Characteristic appearance on exam; like mold growing on spoiled food
   3. Treatment
      1. Cleaning of ear canal
      2. Topical antifungal
3. Contact Dermatitis
   1. Chronic suppurative otitis media
   2. Ear canal findings are usually mild compared with bacterial external otitis
4. Ramsay Hunt syndrome

Treatment

1. Clean the ear canal
   1. Cerumen wire loop or cotton swab
   2. 1:1 dilution of 3% hydrogen peroxide if TM is visible and intact
2. Analgesia
   1. NSAIDs
3. Avoiding promoting factors
   1. Keep ear canal dry
   2. Abstain from water sports for 7-10 days

Antibiotics

1. Ofloxacin (Floxin otic): 5 drops in affected ear BID x 7 days
   • 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

Disposition

• F/u in 1-2wks for pts with moderate disease

See Also

• Otitis Media (Peds)
• Malignant Otitis Externa

Source

• UpToDate
• Tintinalli