Otitis Externa

Question 1

What is otitis externa?

Answer 1

Inflammation of the external auditory canal, most common in children 7-14.

Most common in children aged 7-14.

Question 2

List the risk factors for otitis externa.

Answer 2

• Swimming
• Humidity
• Trauma
• Ear devices use like hearing aids, ear plugs or plugs
• Obstruction from ear wax or foreign object
• Medical conditions like diabetes
• Narrow ear canal
• Radiotherapy or chemotherapy

These factors increase the likelihood of developing otitis externa.

Question 3

What is the pathophysiology of otitis externa?

Answer 3

External auditory canal has cerumen producing glands that create an acidic environment for preventing growth of pathogens. PH alterations like swimming causes inflammation, epithelial a age and reducing cerumen production.

This environment prevents the growth of pathogens, but pH alterations can lead to inflammation.

Question 4

Name the common aetiology agents linked to otitis externa.

Answer 4

• Bacteria: Staphylococcus aureus, Pseudomonas aeruginosa
• Fungi: Candida, Aspergillus
• Seborrheic dermatitis
• Contact dermatitis

These agents can cause infection or inflammation in the external auditory canal.

Question 5

What are the acute cases of otitis externa?

Answer 5

• Acute diffuse otitis externa
• Acute localized externa

Acute cases last up to 6 weeks.

Question 6

What is considered chronic otitis externa?

Answer 6

Otitis externa lasting over 3 months

Chronic cases may have different symptoms and management.

Question 7

List the clinical presentations of otitis externa.

Answer 7

• Otalgia
• Discharge and debris
• Pruritis
• Sensation of ear pressure
• Erythematous and oedematous canal
• Tinnitus
• Hearing loss
• Lymphadenopathy and fever

Symptoms can vary in severity and presentation.

Question 8

How do children with otalgia present?

Answer 8

pulling on pinna and palpation of tragus

Question 9

When is pruiritus more common?

Answer 9

Pruiritus is more common in chronic otitis externa and otomyocsis

Question 10

wHat is otomycosis?

Answer 10

fungal infection of the ear canal

Question 11

In mild otitis externa, what symptoms are present?

Answer 11

• Pruritis
• Mild oedema

Symptoms are less severe compared to moderate or severe cases.

Question 12

In moderate otitis externa, what is the condition of the external auditory canal?

Answer 12

Partially occluded

Symptoms may include more pronounced pain and discharge.

Question 13

In severe otitis externa, what is the condition of the external auditory canal?

Answer 13

Completely occluded with systemic symptoms

This condition requires more intensive management.

Question 14

What is eczematous otitis externa?

Answer 14

Dermatitis within the external auditory canal with pruritus, scaling, and flaking

Clear discharge is also a symptom.

Question 15

What is necrotising otitis externa?

Answer 15

Occurs in immunocompromised patients with severe deep pain

It is a serious condition that requires urgent treatment.

Question 16

What is otomycosis?

Answer 16

Fungal infection of the ear by Candida and Aspergillus. A key differential is malodorous discharge

Key differential includes malodorous discharge.

Question 17

How is otitis externa diagnosed?

Answer 17

*Clinical diagnosis with otoscopy showing red, swollen, or eczematous canal

*Culture in refractory or severe cases for antibiotic treatment

*Imaging only for suspicion mastoiditis and necrotising otitis externa

Cultures may be taken in severe cases.

Question 18

What is the initial management for otitis externa?

Answer 18

• Topical antibiotic
• Combined topical antibiotic with steroid
• Consider removal of canal debris
• Ear wick insertion if swollen

Management depends on severity and symptoms.

Question 19

What are second-line options for treating otitis externa?

Answer 19

• Contact dermatitis management
• Oral antibiotics (e.g., flucloxacillin)
• Swab inside ear canal
• Empirical antifungal agent

These options are considered if initial treatments fail.

Question 20

What to do for mild to moderate otitis externa?

Answer 20

Can be treated with topical drops including combined antibiotic/steroid drops (e.g. Gentamix), acetic acid and other preparations. Patients should be advised to keep the ear dry for the next 7-10 days.

Question 21

What to do for severe otitis externa?

Answer 21

Treated using a strip of ribbon gauze known as undefinedPope” wicks which can be used for the application of topical antibiotics (classically gentamicin) enabling deeper penetration.

Question 22

What are the indications to consider antibiotics in otitis externa?

Answer 22

*Cellulitis extending beyond the external ear canal
* when the ear canal is occluded by swelling and debris a wick cannot be inserted
*in people with diabetes or compromised immunity with severe infection or high risk of severe infection.

If a patient fails to respond to topical antibiotics then the patient should be referred to ENT.

Question 23

What is malignant otitis externa?

Answer 23

Extension of infection into the bony ear canal, more common in elderly diabetics, requiring IV antibiotics

Requires intravenous antibiotics and urgent referral.

Question 24

What is the cause of malignant otitis externa?

Answer 24

• most commonly caused by pseudomonas aeruginosa_
• Infection commences in the soft tissues of the external auditory meatus, then progresses to involve the soft tissues and into the bony ear canal
• Progresses to temporal bone osteomyelitis

Question 25

What are the **key features** in the history of malignant otitis externa?

Answer 25

* Diabetes or immunosuppression * Severe, unrelenting otalgia * Temporal headaches * Purulent otorrhea * Possible dysphagia, hoarseness, facial nerve dysfunction ## Footnote These features help in diagnosing the condition.

Question 26

What is the **diagnosis** method for malignant otitis externa?

Answer 26

CT scan ## Footnote Imaging helps assess the extent of the infection.

Question 27

What are the **differentials** for otitis externa?

Answer 27

* Otitis media * Furunculosis * Eczema ## Footnote Each differential has distinct symptoms and management.

Question 28

What are differentials for otitis externa?

Answer 28

otitis media Furunculosis Eczema

Question 29

what is the presentation of otitis media?

Answer 29

Characterised by middle ear pain, fever, hearing loss and sometimes discharge.

Question 30

What is the presentation of furunculosis?

Answer 30

recurrent or multiple boils (furuncles), which are painful, pus-filled skin infections of hair follicles, usually caused by Staphylococcus aureus bacteria, leading to tender red bumps or nodules that can sometimes form larger carbuncles

Question 31

What are the features of eczema from otitis externa?

Answer 31

Features include itching, redness, and scaling of the skin.

Question 32

What causative organism to suspect in diabetic with otitis sternal?

Answer 32

Pseudomonas aeruginosa

Question 33

What antibiotic to prescribe in diabetic with otitis externa?

Answer 33

Ciprofloxacin ear drops to cover pseudomans aeruginosa because of risk of malignant otitis externa

Question 34

What causes recurrent otitis externa despite antibiotics?

Answer 34

Candidiasis albicans

Question 35

What is the initial medical management of otitis externa?

Answer 35

topical antibiotic or a combined topical antibiotic with a steroid

Question 36

What is the first line single antibiotic for otitis externa?

Answer 36

Flucloxacillin

Question 37

Which drug must be avoided in otitis externa with perforation?

Answer 37

Aminoglycosides due to ototoxicity risk

Question 38

What warrants referral urgently to ENT with otitis externa?

Answer 38

Non-resolving otitis externa with worsening pain should be referred urgently to ENT

Question 39

What does yellow discharge indicate?

Answer 39

Perforation of the tympanic membrane

Question 40

What is the initial management of otitis external?

Answer 40

topical antibiotic or a combined topical antibiotic with a steroid

Question 41

What is the first line for otitis externa?

Answer 41

Topical antibiotic with/without steroid for 1-2 weeks

Question 42

When should ENT referral be done for otitis externa?

Answer 42

No response to topical antibiotics

Question 43

What causes contact dermatitis of the ear canal?

Answer 43

Caused by neomycin

Question 44

What indicates contact dermatitis of ear canal?

Answer 44

intense itching, redness, dry/flaky/crusty skin, swelling, and sometimes a watery or yellowish discharge

Question 45

What causes otalgia and facial weakness with rash?

Answer 45

Ramsay Hunt syndrome -> treat with oral Aciclovir nad coritosteroids

Question 46

Which antibiotic is given for topical treatment in otitis externa?

Answer 46

Ciprofloxacin and gentamicin

Question 47

High antibiotic is given for otitis externa progressing to systemic infection?

Answer 47

Flucloxacillin

Question 48

Which antibiotc is first line for diabetics with otitis externa?

Answer 48

Cirprofloxacn to cover for pseudomonas aeruginosa

Question 49

When to avoid prescribing antibiotics for otitis externa even if patient fulfills all criteria?

Answer 49

the lack of symptoms such as pain in the ear, itching, discharge, or evidence of inflammation on otoscopy

Question 50

What is the biggest risk factor for otitis externa?

Answer 50

Diabetes Immmunosuppression

Question 51

What are key features for malignant otitis externa?

Answer 51

*Severe, unrelenting, deep-seated otalgia *Temporal headaches *Purulent otorrhea *Possibly dysphagia, hoarseness, and/or facial nerve dysfunction

Question 52

When is 2 week referral required for glue ear?

Answer 52

Adult with unilateral glue ear

Question 53

When can patients return to swimming in otitis externa?

Answer 53

With symptom resolution

Question 54

When can pa

Question 55

What to suspect in Non-resolving unilateral discharge?

Answer 55

Cholesteatoma which can be hidden behind attic wax so microsuction and direct inspection is needed