otitis externa

Question 1

what are the causes of OE?

Answer 1

1. infection
   
   • bacterial (s. aureus, pseudomonoas aeruginosa)
   • fungal
2. seborrhoeic dermatitis
3. contact dermatitis
   
   • allergic and irritant

Question 2

what are the features of OE?

Answer 2

• ear pain, itch, discharge
• otoscopy: red, swollen / eczematous canal

Question 3

what is the recommended initial mx of OE?

Answer 3

1. topical abx / combined topical abx + steroid
   
   • _{<strong>​​</strong>e.g. topical ciprofloxacin + dexamethasone}
2. if tympanic membrane perforated ⇒ aminoglycosides not traditionally used
3. if canal debris ⇒ removal
4. if canal extensively swollen ⇒ ear wick insertion

Question 4

in whom is malignant OE more common in?

Answer 4

elderly diabetics

Question 5

what happens in malignant OE?

Answer 5

there is extension of infection into bony ear canal and soft tissues deep into the bony canal. IV abx may be required.

Question 6

A 23-year-old woman presents one week after being prescribed a combined antibiotic and steroid spray for otitis externa. There has been no improvement in her symptoms and the erythema seems to have extended to the ear itself.

What is the most appropriate treatment?

Answer 6

oral flucloxacillin (1st line)

the spreading erythema is an indication for oral antibiotics

Question 7

pain on palpation of tragus, itching, discharge, hearing loss. dx?

Answer 7

otitis externa