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Otitis Externa

Pieter Naudé

Anatomy

2.5 cmS-shapedIsthmusHair folliclesSebaceous + ceruminous glandsCerumen = protective

Clinical overview

Acute Otitis Externa – AOEDiffuse – “swimmer’s ear”Localized – furunculosis

Chronic Otitis Externa – COEOtomycosisNon-infective

Necrotising / Malignant OEHerpes Zoster Oticus (Ramsey-Hunt)

AOE - diffuse / ‘Swimmers Ear’

Infection of EACBacterial

PseudomonasStaph aureus

Rarely complicationsAcute morbidityM = FAll ages

(peak=7-12y)

Background:

AOE - diffuse / ‘Swimmers Ear’

Trapped moistureSwimmersHumid climates

Trauma to EACCotton budsPaper clipsPencils

Pathophysiology:

“Ear cleaning – 15 rupees”

AOE - diffuse / ‘Swimmers Ear’

1-2 days progressive ear painItching Purulent discharge Conductive hearing loss Feeling of fullness or pressure Exposure to water

History:

AOE - diffuse / ‘Swimmers Ear’

Pain on gentle traction of auriclePeri-auriclular adenitisSpeculum:

ErythemaOedemaMoist debris in canalTM difficult to visualise

Examination:

AOE - diffuse / ‘Swimmers Ear’

Dx usually made on history + physical examLab:

Swab for MCS if not responding on Rx

Imaging:Only if complicated

Other:Screen for DM (glucostix)

Diagnosis:

AOE - diffuse / ‘Swimmers Ear’

Topical Quadriderma/b eardrops

SystemicOral a/b usually not indicatedAnalgesia

Keep ear dry

Treatment:

Clinical overview

Acute Otitis Externa – AOEDiffuse – “swimmer’s ear”Localized - furunculosis

Chronic Otitis Externa – COEOtomycosisNon-infective

Necrotising / Malignant OEHerpes Zoster Oticus (Ramsey-Hunt)

AOE – localised / furunculosis

Usually in lateral ⅓Pustule → furuncleLocalised symptomsStaphRx:

not abscess Oral a/bAnalgesia

AbscessI&D

Clinical overview

Acute Otitis Externa – AOEDiffuse – “swimmer’s ear”Localised - furunculosis

Chronic Otitis Externa – COEOtomycosisNon-infective

Necrotising / Malignant OEHerpes Zoster Oticus (Ramsey-Hunt)

COE - otomycosis

Aspergillus and Candida most common1° pathogen or superimposed infection

COE - otomycosis

Sx as for AOEPruritus ++Rx:

topical antifungal(Quadriderm)Acetic acid

Clinical overview

Acute Otitis Externa – AOEDiffuse – “swimmer’s ear”Localised - furunculosis

Chronic Otitis Externa – COEOtomycosisNon-infective

Necrotising / Malignant OEHerpes Zoster Oticus (Ramsey-Hunt)

COE – non-infective

Chronic eczematoidexternal otitis / Seborrhoeic dermatitis Canal is red, scaly, dry Can have 2° bact infOlder womenHair over ears

COE – non-infective

Lichenification if chronicRx:

Hydrocortisone Treat overlying infection if present

Clinical overview

Acute Otitis Externa – AOEDiffuse – “swimmer’s ear”Localised - furunculosis

Chronic Otitis Externa – COEOtomycosisNon-infective

Necrotising / Malignant OEHerpes Zoster Oticus (Ramsey-Hunt)

Necrotising / Malignant OE

DM, elderly, immunocompromisedPseudomonas commonBegins as AOE Progresses to skull base osteomyelitisResultant CN neuropathiesDeep pain ++

Necrotising / Malignant OE

Clinical Laboratory Suspicions – not responding on Rx

CT

Diagnosis:

Necrotising / Malignant OE

IV anti-Pseudomonal antibiotics (4w)Local canal debridementPain controlRx underlying condition

Treatment:

Clinical overview

Acute Otitis Externa – AOEDiffuse – “swimmer’s ear”Localised - furunculosis

Chronic Otitis Externa – COEOtomycosisNon-infective

Necrotising / Malignant OEHerpes Zoster Oticus (Ramsey-Hunt)

Herpes Zoster Oticus

Ramsey-Hunt syndromeHerpes zoster of pinna(‘shingles’)Otalgia and facial paralysis Varicella zoster virus dormant in nerve or ganglion

Herpes Zoster Oticus

Burning pain Headache, malaise, fever for a few daysVesicles appear 3 - 7 days after onset of painUsually erupt on the antihelix, conchal bowl, and postero-lateral EAC

Herpes Zoster Oticus

Acyclovir Oral steroidsCorneal protection

Treatment:

Credits / references

Grand Rounds Of The UTMB Department Of Otolaryngology

http://www.utmb.edu

Otolaryngology Houstonhttp://www.ghorayeb.com