Otitis externa - Revision history

Patricklin at 00:41, 9 November 2023

2023-11-09T00:41:18Z

← Older revision		Revision as of 00:41, 9 November 2023
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	==Background==		==Background==
	[[File:Gray907.png\|thumb\|Ear anatomy]]		[[File:Gray907.png\|thumb\|Ear anatomy]]
			*Inflammation of the external auditory canal (EAC), often due to bacterial infection
			*Common in all age groups, but in the US commonly present in childhood <ref>Beers SL, Abramo TJ. Otitis externa review. Pediatr Emerg Care. 2004 Apr;20(4):250-6. doi: 10.1097/01.pec.0000121246.99242.f5. PMID: 15057182.</ref>
			*In rare cases, immunocompromised patients may have fungal otitis external from Aspergillus or Candida

	===Microbiology===		===Microbiology===
	*[[Pseudomonas]] (most common)		*[[Pseudomonas]] (most common)
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	*[[Enterobacter]]		*[[Enterobacter]]
	*[[Proteus mirabilis]]		*[[Proteus mirabilis]]
	*Fungus (may present after antibiotic treatment)		*Fungus (may present after antibiotic treatment or in immunocompromised patient)
	**[[Aspergillus]]		**[[Aspergillus]]
	**[[Candida]]		**[[Candida]]
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	===Risk Factors===		===Risk Factors===
	*Swimming		*Swimming
	*Excessive Q-tip use		*Excessive Q-tip (or other instrument) use

	==Clinical Features==		==Clinical Features==
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	*''Signs''		*''Signs''
	**Tenderness of the pinaa and/or tragus		**Tenderness of the pinaa and/or tragus
	**Diffuse ear canal edema, erythema		**Diffuse ear canal edema, erythema, and possibly debris
			**Tympanic membrane may not be visualized due to EAC edema
	**Otorrhea		**Otorrhea
	**Local [[lymphadenitis]]		**Local [[lymphadenitis]]
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	==Evaluation==		==Evaluation==
	*Normally clinical		*Normally clinical
			**Routine labwork or EAC cultures typically not necessary

	==Management==		==Management==
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	**1:1 dilution of 3% hydrogen peroxide if tympanic membrane is visible and intact		**1:1 dilution of 3% hydrogen peroxide if tympanic membrane is visible and intact
	**Acetic acid wash for debridement of dead skin		**Acetic acid wash for debridement of dead skin
	**'''Place a wick if the ear canal is fully obstructed'''		*'''Place a wick if the ear canal is fully obstructed'''
			**Instruct patient that the wick should fall out spontaneously in 3 days as swelling decreases; a clinician may remove it otherwise

	===[[Analgesia]]===		===[[Analgesia]]===
	*[[NSAIDs]]		*[[NSAIDs]]
			*[[Acetaminophen]]

	===Prevention===		===Prevention===
	*Keep ear canal dry		*Keep ear canal dry
	**Abstain from water sports for 7-10 days		**Abstain from water sports for 7-10 days
			*Counsel patient to avoid Q-tip or other foreign objects in the ear

	===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>		*Instruct the patient to instill the medication into the ear while laying on their side and hold position for 3-5 minutes
			**Typically a least 4 drops are needed to fill the entire ear canal
			*Consider systemic antibiotics in specific cases:
			**Immunosuppressed (HIV, 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>
			**If TMs are able to be visualized and suggest otitis media
			**If there is a suspicion of malignant otitis externa

	==Disposition==		==Disposition==
	*Follow up in 1-2 weeks for patients with moderate disease		*Discharge
			**Follow up with PCP or ENT in 1-2 weeks for patients with moderate disease

	==See Also==		==See Also==

Rossdonaldson1: /* Disposition */

2023-05-10T16:25:48Z

Disposition

← Older revision		Revision as of 16:25, 10 May 2023
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	==Disposition==		==Disposition==
	*Follow up in 1-~~2wks~~ for patients with moderate disease		*Follow up in 1-2 weeks for patients with moderate disease

	==See Also==		==See Also==

Masoodrm: /* Clinical Features */

2021-06-16T17:49:30Z

Clinical Features

← Older revision		Revision as of 17:49, 16 June 2021
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	;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>		;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''		*''Symptoms''
	**[[earache\|~~otalgia~~]] ~~(often severe)~~		**[[earache\|Otalgia]]
	**itching~~, or fullness, WITH OR WITHOUT~~		**Fullness or itching of the ear
	**[[~~hearing~~ loss]] ~~or jaw~~ pain ~~AND...~~		**[[Hearing loss]]
			**Jaw pain
	*''Signs''		*''Signs''
	**~~tenderness~~ of the tragus~~, pinna, or both OR~~		**Tenderness of the pinaa and/or tragus
	**~~diffuse~~ ear canal edema, erythema~~, or both WITH OR WITHOUT~~		**Diffuse ear canal edema, erythema
	**~~otorrhea~~		**Otorrhea
	**~~regional~~ [[lymphadenitis]]		**Local [[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==

Elcatracho: /* See Also */

2021-02-20T20:08:21Z

ClaireLewis at 22:10, 30 September 2019

2019-09-30T22:10:56Z

← Older revision		Revision as of 22:10, 30 September 2019
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	**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

ClaireLewis: /* Analgesia */

2019-09-24T03:57:57Z

Analgesia

← Older revision		Revision as of 03:57, 24 September 2019
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	**'''Place a wick if the ear canal is fully obstructed'''		**'''Place a wick if the ear canal is fully obstructed'''

	===Analgesia===		===[[Analgesia]]===
	*[[NSAIDs]]		*[[NSAIDs]]

ClaireLewis: /* Clinical Features */

2019-09-24T03:57:37Z

Clinical Features

← Older revision		Revision as of 03:57, 24 September 2019
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	;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>		;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''		*''Symptoms''
	**otalgia (often severe)		**[[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
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	**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==

Rossdonaldson1: /* Background */

2019-08-16T02:15:33Z

Background

← Older revision		Revision as of 02:15, 16 August 2019
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	==Background==		==Background==
			[[File:Gray907.png\|thumb\|Ear anatomy]]
	===Microbiology===		===Microbiology===
	*[[Pseudomonas]] (most common)		*[[Pseudomonas]] (most common)

Rossdonaldson1: /* Antibiotics */

2019-08-13T06:47:55Z

Antibiotics

← Older revision		Revision as of 06:47, 13 August 2019
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	===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>		*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==

Gregtong: /* Antibiotics */

2019-07-23T00:25:01Z

Antibiotics

← Older revision		Revision as of 00:25, 23 July 2019
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	===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==

← Older revision		Revision as of 20:08, 20 February 2021
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	*[[Otitis Media (Peds)]]		*[[Otitis Media (Peds)]]
	*[[Malignant Otitis Externa]]		*[[Malignant Otitis Externa]]
			*[[In-Training Exam Review]]

	==External Links==		==External Links==