Otitis Externa (External Ear Infection)

Last updated 13.02.13

 

Definition

-  Acute infection of external middle ear

 

Features

-  Often follows maceration of ear canal with water

-  Necrotising

-  Seen in elderly, immunocompromised, DM

-  Involved cartilage and bone of external canal +/- base of skull

-  Must exclude if apparent treatment failure

 

Causes

-  Bacterial (most common)

-  Pseudomonas aeruginosa (esp necrotising)

-  Staph aureus (esp furuncle)

-  Proteus

-  Klebsiella

-  Fungal

-  Candida

-  Aspergillus

 

Associated S/S

-  Tympanic membranes

-  Ear Exam

-  Otorrhoea

-  +/- Fever

-  Localised infection

-  Furuncle

-  Erysipelas

-  Necrotising

-  Fever

-  Severe persistant pain

-  Visible granulation tissue

-  Progressive cranial neuropathy

-  Bacterial

-  Very painful, tender tragus

-  Swollen ear canal

-  +/- cellulitis

-  Exostoses

-  Fungal

-  Indolent

-  Less painful

-  Reduced risk of tympanic membrane perforation

 

Ix

-  Vitals: fever

-  Otoscopy

-  Swab for MCS

 

Mx

-  Prevention

-  Aquaear

-  Maintain dry ears

-  Surgery for significant exostoses

-  Maintain dry ear canal

-  Avoid ear syringing

-  Dry aural toilet: suction under direct vision or dry mopping with cotton wool on thin carrier (not cotton bud)

-  Keep dry for 2 weeks post treatment

-  Antibiotics

-  Oral antiobiotics

-  Occassionally indicated

-  Topical Abx + steroid

-  Sofradex, Chloromycetin, Lococorten, Ciproxin HC

-  Dexamethasone 0.05% + Framycetin 0.5% + Gramicidin 0.005% ear drops 3 drops in ear TDS for 3-7/7

-  OR Flumethasone 0.02% + Cliquinol 1% ear drops 3 drops in ear BD for 3-7/7

-  Pump the tragus for 30 seconds after instillation of drops

-  Severe

-  Insertion of wick soaked in Abx + steroid (above or Kenacomb)

-  Acute localised (furuncle or erysipelas)

-  Di/Flucloxacillin

 500mg PO 6/24 for 5/7

-  Children 12.5mg/kg up to 500mg PO 6/24 for 5/7

-  Recurrent

-  +/- acetic acid plus isopropyl alcohol ear drops 4-6 drops each ear after shaking out water post water immersion

-  +/- Water exclusion with earplugs during showering/swimming

-  Necrotising

-  Urgent referral to ID physician or Otolaryngologist

-  Systemic Abx

 

 

 

References

 

eTG: Acute Otits Media, 2012