Otitis Externa

Question 1

Symptoms

Answer 1

• Unilateral (90%)
• Pain / Otalgia
• Pruritis
• Odourless Secretion
• Erythema
• Fullness
• (late stage) edema, otorrhea, conductive hearing loss (32%)

Question 2

Risk Factors

Answer 2

• HPI: Swimming, Local Trauma
• PMHx: Immunocompromised / T2DM, Hearing Aid / Hearing Protector
• Humidity
• Warmer Temperatures

Question 3

DDX

Answer 3

• Mastoiditis
• Meningitis
• Brain Abscess
• Malignant Otitis Externa
• Venous Sinus Thrombosis
• Cholesteatoma
• Tumour
• Otitis Media
• Trauma / Perforated Ear Drum
• Cerumen Impaction
• Foreign Body
• Coryza Causing eustachian Tube dysfunction

Question 4

DDX

Answer 4

• Mastoiditis
• Meningitis
• Brain Abscess
• Malignant Otitis Externa
• Venous Sinus Thrombosis
• Cholesteatoma
• Tumour
• Otitis Media
• Trauma / Perforated Ear Drum
• Cerumen Impaction
• Foreign Body
• Coryza Causing eustachian Tube dysfunction

Question 5

Initial Non-Pharmacologic management

Answer 5

• Clear obstructing debris / cerumen and check TM

* Suction / Curette / Spoon rather than irrigation

Question 6

Pharmacologic Management: First line no perf, second line no perf, first line perf, fungal

Answer 6

First Line NO Perforation:
• Polysporin eye + ear drops 1-2 drops QID
Second Line NO Perforation OR First Line w/ Perforation:
• Ciprodex otic suspension 4 drops BID
Consider oral Abx if immunocompromized / T2DM / Advanced age / Concomitant OM
Fungal:
• Clotrimazole
• Tolnaftate
• Locacorten