Otitis Externa

Hannah Nahdia
Otitis Externa (OE)
- Inflammation of the external auditory canal
 Risk Factors Diagnosis

- Swimming/other water - Clinical diagnosis: Hx, PE

exposure
- Trauma
- Devices occluding ear canal i t i s
- Contact dermatitis t Otoscope finding
o
- Ear canal is edematous and
erythematous
Symptoms - TM may be partially visible
due to canal edema
- Otalgia
- Pruritus
- Discharge
- Hearing loss Treatment

a
- Cleaning the ear canal (aural
n toilet)
Physical Examination r
e x t e - Topical antibiotics
- Signs of trauma - Topical glucocorticoids
- Tender on tragal pressure - NSAIDs
or auricular manipulation - General counselling
- Otoscope - Clinical follow-up
Divisions of Otitis Externa

Infective
Bacterial
- Localized OE (Furuncle)
- Diffuse OE
- Malignant OE (MOE)
Reactive
- Eczematous OE
- Seborrhoeic OE
- Neurodermatitis

Fungal

- Otomycosis

Viral

- Herpes zoster oticus

- OE haemorrhagica
 Furuncle (Localized OE)
● Staphylococcal infection of the hair follicle
● Only seen in the lateral part of the meatus (cartilaginous part)
● Usually single, may be multiple
● Complains of: severe pain and tenderness, pinna and jaw movement causes pain
● Treatment:
○ Early without abscess - Systemic antibiotics, analgesics, local heat, 10% ichthammol glycerin
○ Early with abscess - Incision and drainage
○ Recurrent furunculosis - exclude diabetes, pay attention to nasal vestibules
 ● Diffuse inflammation of meatal skin
which may spread to involve pinna
and epidermal layer of the tympanic
membrane

Diffuse Otitis ● Commonly: hot and humid climates,

swimmers

Externa
● Two factors:
○ Trauma to meatal skin
○ Invasion by pathogenic organism
(S. aureus, P. pyocyaneus, B.
proteus, E.coli)
 Acute Phase Diffuse OE
- Hot burning sensation
- Pain aggravated by movement
- Ear discharge (initially serous and later
becomes thick and purulent)
- Meatal lining inflamed and swollen
- Conductive hearing loss
- Severe cases: LN enlarged, cellulitis of
surrounding tissue
Chronic Phase
- Irritation and strong desire to itch
- Responsible for acute exacerbations and
reinfection
- Scanty discharge which may dry and form
crusts
- Meatal skin thick and swollen (+ scaling,
fissuring)
- Rarely, skin hypertrophic leading to meatal
stenosis (chronic stenosis OE)
 Treatment of Diffuse OE
Acute phase
● Ear toilet
○ Dry mopping, suction
clearance or irrigating the
canal with warm, sterile
normal saline
● Medicated wicks
○ Gauze wick soaked in
antibiotic steroid preparation
○ Local steroid drops
○ Aluminium acetate/silver
nitrate
● Antibiotics: broad spectrum
● Analgesics
Chronic phase
Aim of treatment
● Reduction of meatal swelling so
that ear toilet can be effectively
done
○ Gauze wick soaked in 10%
ichthammol glycerine
● Alleviation of itching so that
scratching is stopped and further
recurrences controlled
○ Antibiotic steroid cream
OE Haemorrhagica Herpes Zoster Oticus
Formation of haemorrhagic bullae on tympanic Formation of vesicles on the tympanic membrane,
membrane and deep meatus meatal skin, concha and postauricular groove
 ● Result of hypersensitivity to infective
organisms or topical ear drops
(chloromycetin, neomycin)

Eczematous
● Marked by intense irritation, vesicle
formation, oozing and crusting in the
canal

Otitis Externa ● Treatment:

○ Withdrawal of topical antibiotic
○ Application of steroid cream
Seborrhoeic OE
● Associated with seborrhoeic
dermatitis of the scalp
● Main complaint: itching
● Greasy yellow scales seen in the
external canal, over the lobule and
postauricular sulcus
● Treatment:
○ Ear toilet
○ Application of cream containing
salicylic acid and sulfur
○ Attention to scalp
 ● Due to compulsive scratching
● Main complaint: intense itching

Neuro- ● Bacterial OE may follow infection of

raw area caused by scratching

dermatitis
● Treatment:
○ Sympathetic psychotherapy
○ Ear pack and bandage
References
- Diseases of Ear, Nose and Throat. 7th Edition. Authors: P L Dhingra.
- Color Atlas of Endo-Otoscopy. Examination–Diagnosis–Treatment. Mario Sanna.
- UpToDate
- BMJ

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