Otitis Externa

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This condition refers to the Inflammation of the external ear. This can be diffused or localized; acute or chronic; inflammatory or infectious as the case may be.

Causes

• Infections: mostly due bacteria e.g. streptococcus, staphylococcus aureus, Ps. pyocyanea, B. proteus and E. coli but may also be due to fungi e.g. Candida (whitish) or aspergilla (blackish) or herpes zoster virus.
• It may also occur in generalized allergic and seborrheic states.
• Trauma: this can be blunt or penetrating injuries

Signs and symptoms

• Pain and tenderness accentuated by movement of the tragus.
• Pre or post auricular or cervical lymphadenitis may be present.
• Swelling with obliteration of the canal lumen may occur due to inflammation causing deafness.
• Discharge (mucoid, purulent, mucopurulent, bloodstained, bloody or clear) may be offensive or odourless with or without itching.
• Fever (though uncommon) may be present.
• Redness of the canal and/ear drum with or without haematoma
• Ulceration of the external canal wall with or without granulomatous formation

Investigations

• Investigation is based on clinical features
• X-ray of the temporal bone or CT- Scan as may be required

Non-pharmacological treatment 

Exclude any underlying suppurative otitis media. If suppurative otitis media is diagnosed, see Section on Otitis media, chronic, suppurative.

• Most cases recover after thorough cleansing and drying of the ear.
• Keep the ear clean and dry (dry mopping).
• Do not leave pieces of cotton wool, etc. in the ear.
• Do not instil anything into the ear unless prescribed.

Pharmacological treatment 

Otitis Eterna (Furuncle)

Clinical Diagnosis	Antibiotic	Duration	Comments
Acute Otitis Eterna (Furuncle)	Ciprofloxacin oral 500mg every 12 hours  PLUS Tropical steroid	5 days
Acute Diffuse Otitis Externa (swimmers ear)	Mild to moderate Topical Antimicrobial	7 days
	Severe (e.g. Cellulitis or blocked ear canal): Ciprofloxacin oral 500mg every 12 hours
Perichondritis	First line Ciprofloxacin oral 500mg – 750mg every 12 hours   Second line ADD   Clindamycin oral 450mg every 6 hours	7 days
Malignant Otitis Externa	Clindamycin IV 900mg every 8 hours   PLUS Topical treatment   Oral Step down Ciprofloxacin oral 500mg – 750mg every 12 hours	4 – 6 weeks	-     Ensure swabs are taken prior to starting topical therapy -     Switch to orals based on clinical assessment and microbiological results -     Assess for any bone and intracranial extension -     Discuss all cases with microbiology