Otitis Externa Definition - PowerPoint Presentation

Slide1

Otitis Externa

Definition

Otitis externa (OE)

also known as “swimmer’s ear”

either an inflammation or infection of the external auditory canal (EAC) or the auricle or sometimes both.

Usually due to bacterial infection of the skin of the ear canal

Common bacterial pathogen include

Pseudomonas aeruginosa

Enterobacteriaceae

Staphylococcus aureus

Epidemiology

Found in all regions of the US

4 in every 1000 people annually

Affects both sexes equally

Infection is most prevalent in older pediatric and young adult patients (

peak incidence in children age 7-12)

and those 65 and older

Signs and Symptoms

The key physical finding of OE is

pain with movement of the tragus

or

the pinna

(the hallmark of OE).

Other signs and symptoms include:

Otalgia

Pruritus

Ear fullness or pressure

Narrowing of the external auditory canal

Tinnitus

Fever

Discharge

Common History Findings

History of exposure to or activities in water

History of recent ear trauma (forceful ear cleaning, cleaning ear with cotton swabs)

Classification

Acute diffuse OE

Acute localized OE

Chronic OE

Eczematous (

eczematoid

) OE

Necrotizing (malignant) OE 

Otomycosis

Acute Localized Otitis Externa

This condition, also known as furunculosis, is associated with infection of a hair follicle

Acute Diffuse Otitis Externa

This is the most common form of OE, typically seen in swimmers; it is characterized by rapid onset (generally within 48 hours) and symptoms of EAC inflammation as well as tenderness of the tragus or pinna or diffuse ear edema or erythema or both, with or without otorrhea, regional lymphadenitis, tympanic membrane erythema, or cellulitis of the pinna

Otoscopic Appearance:Canal edema with erythema and exudate

L3

Chronic Otitis Externa

This is the same as acute diffuse OE but is of longer duration (>6 weeks)

Otoscopic

appearance:

Skin of the external canal is shiny

Skin may be erythematous

Normal cerumen is usually absent

Skin lining the deep canal may show

marked

hyperemia

and is often covered in white patchy and purulent exudate.

Necrotizing (malignant) Otitis Externa

Infection that extends into the deeper tissues adjacent to the EACPrimarily occurs in adult patients who are immunocompromised (rarely in children)It may result in cases of cellulitis and osteomyelitis

Otoscopic

appearance:

Key finding is an area of infected granulation tissue on the floor of the cartilaginous ear canal near the junction between the cartilaginous and bony portions of the canal.

Meatus filled with purulent discharge

Otomycosis

Infection of the ear canal secondary to fungus species such as Candida or Aspergillus

Otomycosis caused by Candida. Note the characteristic white fungal elements on the debris.

Otomycosis caused by Aspergillus. Note the characteristic gray-black fungal elements on the debris.

Otomycosis

Otoscopy Appearance: Examination of right external auditory canal shows slightly edematous and erythematous canal leading to impacted debris. Note the yellow purulence surrounding the white mycelium of the fungal infection with a few black conidiophores (fruiting body of fungus) intermixed. Red arrow denotes superior orientation.

R2

Eczematous (eczematoid) Otitis Externa

Various dermatologic conditions that may infect the EAC and cause OE

DiagnosisGeneral

Clinical Diagnosis (Otoscopy examination)

necrotizing OE needs to be ruled out by an otolaryngologist if patients is diabetic or immunocompromised and presents with severe pain in the ear.

DiagnosisLab testing

Usually only indicated if the patient is immunocompromised, if symptoms are refractory to treatments, or if a fungal etiology is suspected.

Tests may include the following:

1) Gram Stain

2) Blood glucose level

3) Urine dipstick

DiagnosisImaging

Indication for imaging if suspecting either

necrotizing

OE or

mastoiditis

.

Imaging modalities

1) CT (preferred for better resolution of bone erosion)

2)

Radionucleotid

bone scanning

3) Gallium scanning

4) MRI (used if soft tissue extension is the primary concern)

Treatment

Primary treatment of otitis externa

1) management of pain

2)

Cleaning the EAC

3) Topical antibiotics and steroids

4) IV antibiotics may be needed for individuals at risk for

necrotizing OE

Most cases can be treated with

OTC analgesics

and

topical eardrops

Surgical debridement is rarely indicated