otitis externa

what is otitis externa also known as?

swimmers ear

what is otitis externa?

inflammation of external auditory canal

what is the classic presentation of otitis externa?

- otalgia (ear pain)

- discharge

- tragal tenderness +/- itch

dot

what would be seem on examination of ear canal?

- erythema and swelling of ear canal

- pus or discharge in ear

- lymphadenopathy in neck or around ear

what are the causes of otitis externa?

infectious:

- bacterial (most common)

- fungal

- viral

non-infectious:

- neurodermatitis - compulsive scratching

- eczematous OE

- persistant unilateral OE

- ear canal occlusion

- immunosuppression

what are the common bacteria causing OE?

- pseudomonas aeruginosa (from swimming) - gram -ve

- staph aureus

- staph epidermis

what are the common fungi causing OE?

- candida albicans

- aspergillus niger

what are the common viruses causing OE?

- herpes zoster

- influenza

what are the causes of persistant unilateral OE?

- diabetes

- immunosuppressed

- elderly

they are at risk of malignant/necrotising OE

what are the symptoms of OE?

- otalgia (particularly at night)

- otorrhoea

- intense itching

- hearing loss

- tinnitus

what are the signs of OE?

- tragal tenderness

- pulling auricle up and back causes pain

- oedema and erythema of ear canal

- yellow, white, grey or brown purulent dbris

- CHL

- otoscopic findings

- lymphadenopathy

what are the investigations for OE?

otoscopy

what is the management of bacterial OE?

1) neomycin (aminoglycoside) drops + topical steroid for pain management 7-14 days

2) above ^ + systemic abx (flucoxacillin) if immunocompromised/diabetic

what is a contraindication to neomycin drops?

tympanic membrane perforation

what is the management of fungal OE?

cleansing of ear + acetic acid (earcalm)/clotrimazole drops + pain management

what should be avoided if possible tympanic perforations?

ototoxic drops (aminoglycosides)

what can be used before and after swimming and why?

acetate - has antifungal + antibacterial effects