Otitis Externa

Notes
  • Otitis externa (OE) is the inflammation of external ear (the auricle, external auditory canal and outer surface of the eardrum).

##Causes of OE:

  • Bacterial infections (which is the most common cause and the bacteria that are mostly involved are pneumonie, S. aureus, Ps. Pyocyanea, E. coli and B. proteus)
  • Candida (otomycosis) – whitish discharge
  • Aspergilla – blackish discharge
  • Herpes zoster virus
  • Allergic reaction

##Risk factors for OE:

  • Diabetes mellitus
  • HIV
  • Swimming
  • Blocked or narrow external auditory meatus
  • Inadequate or excessive cerumen (wax)
  • Allergic or seborrhoeic dermatitis
  • Eczema
  • Physical damage to the ear
  • Otitis media
  • Infections e.g. by Pseudomonas aeruginosa or fungi.
Symptoms
  • Occasionally, there is ear discharge
  • Pain that worsens with the movement of tragus
  • Mobile tympanic membrane
  • Cellulitis (sometimes spreading beyond the ear)
  • Deafness due to the blockage of the canal lumen by inflammatory swelling
  • Pre or post - auricular or cervical lymphadenitis
  • Regional lymphadenopathy
Diagnosis
  • Clinical evaluation
Differential
  • Chronic otitis media
Prevention
  • Keep the ear dry much as possible (even during and after swimming)
  • Do not use cotton swabs to remove wax
Management
  • Analgesics such as: Syr/Tabs Paracetamol  10mg /Kg TID x 5/7
  • Antibiotics: in severe case: IM Benzyl penicillin 50,000 units/kg STAT then Syr / Caps Amoxicillin 25-50mg /kg TID x 5/7
  • Instill Gentamycin ear drop OR 2% Acetic acid ear drops
  • For otomycosis: Clotrimazole 1% ear drops TID  for at least  10 days
  • For Allergic / eczematous otitis externa: Chlorpheniramine 4mg/kg BD for children AND Hydrocortisone ear drops BD     
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