Otitis externa

Background
Ear anatomy

Microbiology

Risk Factors
  • Swimming
  • Excessive Q-tip use

Clinical Features
Mild otitis externa
Severe otitis externa
Rapid onset (generally within 48 hours) in the past 3 weeks, AND.[1]
  • Symptoms
  • Signs
    • 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

Ear Diagnoses

External

Internal

Inner/vestibular

Evaluation
  • Normally clinical

Management

Hygiene
  • Clean the ear canal (Grade C)
    • Cerumen wire loop or cotton swab usually works best
    • 1:1 dilution of 3% hydrogen peroxide if tympanic membrane is visible and intact
    • Acetic acid wash for debridement of dead skin
    • Place a wick if the ear canal is fully obstructed

Analgesia

Prevention
  • Keep ear canal dry
    • Abstain from water sports for 7-10 days

Antibiotics
  1. Floxin otic: 5 drops in affected ear BID x 7 days[1]
    • Safe with perforations
  2. Cipro HC otic: 3 drops in affected ear BID x 7 days
    • Contains hydrocortisone to promote faster healing
    • Not safe with perforation
  3. CiproDex: 4 drops in affected ear BID x 7 days
  4. Cortisporin otic (neomycin/polymixin B/hydrocortisone)
    • 4 drops in ear TID-QID x 7days
    • Use suspension (NOT solution) if possiblity of perforation
    • Animal studies suggest possible toxicity from the neomycin although rigorous data is lacking[2]
  • Immunosuppressed (poorly controlled diabetes, chemotherapy, chronic high dose corticosteroid use, immunosuppressive drugs, neutropenia) give systemic antibiotic (ciprofloxacin or ofloxacin) [3]

Disposition
  • Follow up in 1-2wks for patients with moderate disease

See Also

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