Otitis Externa
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Introduction
Otitis externa is the inflammation of the external ear which may result from a variety of insults to the external ear.
May be classified as localized or diffuse otitis externa; or acute or chronic otitis externa
AetiologyMay be:
- Infective: bacteria or fungi
- Localized otitis externa or furuncle (boil) is a Staphylococcal infection of a hair follicle in the canal
- Diffuse otitis externa may be bacterial or fungal or reactive
- Bacterial infection often follows trauma from scratching the canal skin.
- Fungal otitis (otomycosis) commonly follows swimming in the tropics, usually infection by Aspergillus niger
- Reaction of the canal skin to chemical irritant(s)
- Part of a generalized dermatitis
Clinical features
- Pain and itching
- Ear discharge
- Sensation of blockage due to accumulated debris in canal
- Deafness is variable
- Canal is red and swollen, full of inflammatory debris
- In otomycosis whitish mass of debris with black spots
Differential diagnoses
- Otitis media
- Acute mastoiditis
Complications
- Acute perichondritis
Investigations
- Ear swab, taken properly for microscopy, culture and sensitivity
- Ear endoscopy
- Urinalysis for glycosuria
- Blood glucose estimation in cases of recurrent furunculosis to exclude diabetes mellitus
Treatment goals
- Control infection/inflammation
- Relieve discomfort
Non-drug treatment
- Careful ear toilet to clear out debris
- Daily dressing with antiseptic gauze packed with Acriflavin in spirit
- Furunculosis: dressing with magnesium sulfate wick or steroid and antibiotic ointment dressing
Drug treatment
- Antibiotics
- Amoxicillin
- Adult: 500 mg - 1 g orally every 8 hours for 5 - 7 days
- Child: 40 mg/kg orally in every 8 hours for 5 - 7 days
- Neomycin/hydrocortisone ear drops
- Adult and child: 2 - 3 drops 3 - 4 times daily
- Amoxicillin
- Analgesics
- Paracetamol
- Adult:500 mg -1 g orally every 4 - 6 hours (maximum of 4 g daily) for 5-7 days
- Child
- over 50 kg: same as adult dosing
- 6 - 12 years: 250 - 500 mg 4 - 6 hourly
- 3 months - 5 years: 125 – 250 mg taken orally every 4 - 6 hours
Supportive measures
- Prevent water from entering ear for one month
Prevention
- Avoid trauma to ear canal (especially scratching)
- Keep ears dry