Otitis externa: Difference between revisions
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==Background== | ==Background== | ||
===Microbiology=== | ===Microbiology=== | ||
*Staph/Strep | |||
*Pseudomonas | |||
*Enterobacter | |||
*Proteus | |||
*Fungus | |||
**Aspergillus, candida (may present after abx tx) | |||
===Risk Factors=== | ===Risk Factors=== | ||
*Swimming | |||
*Excessive Q-tip use | |||
==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 | |||
[http://www.aepap.org/sites/default/files/otitis_externa_guia2014-rosenfeld-161-8_0.pdf PDF]</ref> | [http://www.aepap.org/sites/default/files/otitis_externa_guia2014-rosenfeld-161-8_0.pdf PDF]</ref> | ||
* ''Symptoms'' of ear canal inflammation, which include: | |||
**otalgia (often severe) | |||
**itching, or fullness, WITH OR WITHOUT | |||
**hearing loss or jaw pain AND... | |||
* ''Signs'' of ear canal inflammation, which include: | |||
**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== | ==Differential Diagnosis== | ||
*[[Malignant Otitis Externa]] | |||
*Otomycosis | |||
**Pts complain more of itching than pain | |||
**Characteristic appearance on exam; like mold growing on spoiled food | |||
**Treatment | |||
***Cleaning of ear canal | |||
***Topical antifungal | |||
*Contact Dermatitis | |||
**Chronic suppurative otitis media | |||
**Ear canal findings are usually mild compared with bacterial external otitis | |||
*[[Ramsay Hunt syndrome]] | |||
==Treatment== | ==Treatment== | ||
*Clean the ear canal | |||
**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 | |||
===Antibiotics=== | ===Antibiotics=== | ||
{{Otitis Externa Antibiotics}} | {{Otitis Externa Antibiotics}} | ||
Revision as of 21:49, 1 March 2015
Background
Microbiology
- Staph/Strep
- Pseudomonas
- Enterobacter
- Proteus
- Fungus
- Aspergillus, candida (may present after abx tx)
Risk Factors
- Swimming
- Excessive Q-tip use
Diagnosis
- Rapid onset (generally within 48 hours) in the past 3 weeks, AND.[1]
- Symptoms of ear canal inflammation, which include:
- otalgia (often severe)
- itching, or fullness, WITH OR WITHOUT
- hearing loss or jaw pain AND...
- Signs of ear canal inflammation, which include:
- 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
- Malignant Otitis Externa
- Otomycosis
- Pts complain more of itching than pain
- Characteristic appearance on exam; like mold growing on spoiled food
- Treatment
- Cleaning of ear canal
- Topical antifungal
- Contact Dermatitis
- Chronic suppurative otitis media
- Ear canal findings are usually mild compared with bacterial external otitis
- Ramsay Hunt syndrome
Treatment
- Clean the ear canal
- 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
Antibiotics
- Ofloxacin (Floxin otic): 5 drops in affected ear BID x 7 days[2]
- 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[3]
Disposition
- F/u in 1-2wks for pts with moderate disease
See Also
Source
- UpToDate
- Tintinalli
- ↑ Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 PDF
- ↑ 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.