Description
Otitis externa is the inflammation or infection of the external auditory canal (EAC), the auricle, or both. This condition can be found in all age groups.
Types of Otitis Externa:
- Acute diffuse OE: Most common form of OE, typically seen in swimmers.
- Acute localized OE (furunculosis): Associated with infection of a hair follicle.
- Chronic OE: Same as acute diffuse OE but is of longer duration (>6 weeks).
- Eczematous OE: Encompasses various dermatologic conditions that may infect the EAC and cause OE.
- Otomycosis: Infection of the ear canal from a fungal species (e.g., Candida, Aspergillus).
Signs and Symptoms
- Painful ear
- Ear fullness
- Hearing loss
- Occasionally discharging ear (weeping ear)
- Severe cases present with lymph node swelling around the ear and fever
Treatment
Supportive
- Keep the ear dry at all times.
- Plug with a cotton ball smeared with petroleum jelly when taking a bath.
- Avoid inserting anything into the ear (including ear buds).
Pharmacological
Pain Management:
- Paracetamol (Acetaminophen):
- Adults: 500 mg to 1 g every 6-8 hours.
- Children 6-12 years: 250-500 mg every 6-8 hours.
- Children 1-5 years: 120-250 mg every 6-8 hours.
- Ibuprofen:
- Adults: 200-400 mg every 8 hours.
- Children 4-7 years: 150 mg every 8 hours (maximum 7.5-10 mg/kg daily).
- Children 7-12 years: 200 mg every 8 hours (maximum 7.5-10 mg/kg daily).
- Diclofenac:
- Adults: 50-100 mg every 12 hours.
Topical Medications:
- Betamethasone Sodium Phosphate 0.1% Eye/Ear/Nose Drops: Indicated for inflammation in otitis externa with eczema present. Instil 2-3 drops in the ear every 2-4 hours, reduce frequency when relief is obtained.
- Dexamethasone Sodium Phosphate 0.1%: Indicated for inflammation in otitis externa with eczema present. Instil 2-3 drops every 2-3 hours, reduce frequency when relief is obtained. Caution: Use under expert supervision, avoid prolonged use.
- Ciprofloxacin 0.3% Ear Drops: Indicated for acute localized OE and chronic OE.
- Children 1–17 years: Apply 0.25 mL twice daily for 7 days.
- Adults: Apply 0.25 mL twice daily for 7 days.
- Otic Clotrimazole 1% Solution: Indicated for otomycosis.
- Children and Adults: Apply 2-3 drops 2-3 times a day, continue for at least 14 days after disappearance of infection.
Systemic Antibiotics: For severe otitis externa.
- Amoxicillin: 25 mg/kg three times daily for 5-7 days
- If penicillin-hypersensitive:
- Erythromycin: 10-20 mg/kg orally twice daily.
- Cephalexin: 6.25 mg/kg orally every 6 hours.
- Ciprofloxacin: 10mg/kg orally every 12 hours
Avoidance of Contributing Factors