Otitis externa: Difference between revisions
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==Diagnosis==
==Diagnosis==
# Rapid onset (generally within 48 hours) in the past 3 weeks, AND.<ref>Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161
# Rapid onset (generally within 48 hours) in the past 3 weeks, AND.<ref>Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161
[http://www.aepap.org/sites/default/files/otitis_externa_guia2014-rosenfeld-161-8_0.pdf PDF]
[http://www.aepap.org/sites/default/files/otitis_externa_guia2014-rosenfeld-161-8_0.pdf PDF]</ref>
# ''Symptoms'' of ear canal inflammation, which include:  
# ''Symptoms'' of ear canal inflammation, which include:  
##otalgia (often severe)
##otalgia (often severe)

Revision as of 21:21, 25 July 2014

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. Rapid onset (generally within 48 hours) in the past 3 weeks, AND.[1]
  2. Symptoms of ear canal inflammation, which include:
    1. otalgia (often severe)
    2. itching, or fullness, WITH OR WITHOUT
    3. hearing loss or jaw pain AND...
  3. Signs of ear canal inflammation, which include:
    1. tenderness of the tragus, pinna, or both OR
    2. diffuse ear canal edema, erythema, or both WITH OR WITHOUT
    3. otorrhea
    4. regional lymphadenitis
    5. tympanic membrane erythema, or
    6. cellulitis of the pinna and adjacent skin

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[2]
    • 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[3]

Disposition

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

See Also

Source

  • UpToDate
  • Tintinalli
  1. ↑ Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 PDF
  2. ↑ Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 PDF
  3. ↑ 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.
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