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Otitis Externa
Pieter Naudé
Anatomy
2.5 cmS-shapedIsthmusHair folliclesSebaceous + ceruminous glandsCerumen = protective
Clinical overview
Acute Otitis Externa – AOEDiffuse – “swimmer’s ear”Localized – furunculosis
Chronic Otitis Externa – COEOtomycosisNon-infective
Necrotising / Malignant OEHerpes Zoster Oticus (Ramsey-Hunt)
AOE - diffuse / ‘Swimmers Ear’
Infection of EACBacterial
PseudomonasStaph aureus
Rarely complicationsAcute morbidityM = FAll ages
(peak=7-12y)
Background:
AOE - diffuse / ‘Swimmers Ear’
Trapped moistureSwimmersHumid climates
Trauma to EACCotton budsPaper clipsPencils
Pathophysiology:
“Ear cleaning – 15 rupees”
AOE - diffuse / ‘Swimmers Ear’
1-2 days progressive ear painItching Purulent discharge Conductive hearing loss Feeling of fullness or pressure Exposure to water
History:
AOE - diffuse / ‘Swimmers Ear’
Pain on gentle traction of auriclePeri-auriclular adenitisSpeculum:
ErythemaOedemaMoist debris in canalTM difficult to visualise
Examination:
AOE - diffuse / ‘Swimmers Ear’
Dx usually made on history + physical examLab:
Swab for MCS if not responding on Rx
Imaging:Only if complicated
Other:Screen for DM (glucostix)
Diagnosis:
AOE - diffuse / ‘Swimmers Ear’
Topical Quadriderma/b eardrops
SystemicOral a/b usually not indicatedAnalgesia
Keep ear dry
Treatment:
Clinical overview
Acute Otitis Externa – AOEDiffuse – “swimmer’s ear”Localized - furunculosis
Chronic Otitis Externa – COEOtomycosisNon-infective
Necrotising / Malignant OEHerpes Zoster Oticus (Ramsey-Hunt)
AOE – localised / furunculosis
Usually in lateral ⅓Pustule → furuncleLocalised symptomsStaphRx:
not abscess Oral a/bAnalgesia
AbscessI&D
Clinical overview
Acute Otitis Externa – AOEDiffuse – “swimmer’s ear”Localised - furunculosis
Chronic Otitis Externa – COEOtomycosisNon-infective
Necrotising / Malignant OEHerpes Zoster Oticus (Ramsey-Hunt)
COE - otomycosis
Aspergillus and Candida most common1° pathogen or superimposed infection
COE - otomycosis
Sx as for AOEPruritus ++Rx:
topical antifungal(Quadriderm)Acetic acid
Clinical overview
Acute Otitis Externa – AOEDiffuse – “swimmer’s ear”Localised - furunculosis
Chronic Otitis Externa – COEOtomycosisNon-infective
Necrotising / Malignant OEHerpes Zoster Oticus (Ramsey-Hunt)
COE – non-infective
Chronic eczematoidexternal otitis / Seborrhoeic dermatitis Canal is red, scaly, dry Can have 2° bact infOlder womenHair over ears
COE – non-infective
Lichenification if chronicRx:
Hydrocortisone Treat overlying infection if present
Clinical overview
Acute Otitis Externa – AOEDiffuse – “swimmer’s ear”Localised - furunculosis
Chronic Otitis Externa – COEOtomycosisNon-infective
Necrotising / Malignant OEHerpes Zoster Oticus (Ramsey-Hunt)
Necrotising / Malignant OE
DM, elderly, immunocompromisedPseudomonas commonBegins as AOE Progresses to skull base osteomyelitisResultant CN neuropathiesDeep pain ++
Necrotising / Malignant OE
Clinical Laboratory Suspicions – not responding on Rx
CT
Diagnosis:
Necrotising / Malignant OE
IV anti-Pseudomonal antibiotics (4w)Local canal debridementPain controlRx underlying condition
Treatment:
Clinical overview
Acute Otitis Externa – AOEDiffuse – “swimmer’s ear”Localised - furunculosis
Chronic Otitis Externa – COEOtomycosisNon-infective
Necrotising / Malignant OEHerpes Zoster Oticus (Ramsey-Hunt)
Herpes Zoster Oticus
Ramsey-Hunt syndromeHerpes zoster of pinna(‘shingles’)Otalgia and facial paralysis Varicella zoster virus dormant in nerve or ganglion
Herpes Zoster Oticus
Burning pain Headache, malaise, fever for a few daysVesicles appear 3 - 7 days after onset of painUsually erupt on the antihelix, conchal bowl, and postero-lateral EAC
Herpes Zoster Oticus
Acyclovir Oral steroidsCorneal protection
Treatment:
Credits / references
Grand Rounds Of The UTMB Department Of Otolaryngology
http://www.utmb.edu
Otolaryngology Houstonhttp://www.ghorayeb.com
