Tympanic membrane inflammation, may have vesicles pain is often severe, no canal edema Medical emergency with high morbidity rate and possible mortality warrants emergent consultation with otolaryngologist, hospitalization, intravenous antibiotics, debridement High fever, granulation tissue or necrotic tissue in ear canal, may have cranial nerve involvement patient with diabetes mellitus or immunocompromise, elevated erythrocyte sedimentation rate, findings on computed tomography Itching is predominant symptom often chronic history of atopy, outbreaks in other locationsĬonsider treatment with topical corticosteroidsįocal infection, may be pustule or nodule, often in distal canalĬonsider treatment with heat, incision and drainage, or systemic antibiotics can progress to diffuse otitis externa Itching is often predominant symptom, erythematous canal, lasts more than three monthsĬhronic otorrhea, nonintact tympanic membraneĬontrol otitis externa symptoms, then treat otitis mediaĪllergic reaction to materials (e.g., metals, soaps, plastics) in contact with the skin/epithelium itching is predominant symptomĬheck for piercings, hearing aids, or earplug use discontinue exposure when possible Use pneumatic otoscopy or tympanometry, treat with systemic antibiotics Presence of middle ear effusion, no tragal/pinnal tenderness Widely performed in research studies, but no data on effectiveness Use of aural toilet should be considered to remove debris from the ear canal before treatment. Systemic antibiotics should be used only if the infection has spread beyond the ear canal or in patients at high risk of such spread. May be partly dependent on strength of corticosteroid Topical antimicrobial otic preparations should be considered the first-line treatment foruncomplicated acute otitis externa.Ĭhoose specific preparation based on risk of adverse effects, tympanic membrane status, cost, adherence issues, etc.Īddition of a topical corticosteroid may result in faster resolution of symptoms such as pain, canal edema, and canal erythema. Chronic otitis externa is often caused by allergies or underlying inflammatory dermatologic conditions, and is treated by addressing the underlying causes.Īcute otitis externa should be distinguished from other possible causes of ear canal inflammation.ĭifferent and overlapping pathologies may require alteration in treatment Oral antibiotics are reserved for cases in which the infection has spread beyond the ear canal or in patients at risk of a rapidly progressing infection. Neomycin/polymyxin B/hydrocortisone preparations are a reasonable first-line therapy when the tympanic membrane is intact. The choice of treatment is based on a number of factors, including tympanic membrane status, adverse effect profiles, adherence issues, and cost. However, there is no good evidence that any one antimicrobial or antibiotic preparation is clinically superior to another. These agents come in preparations with or without topical corticosteroids the addition of corticosteroids may help resolve symptoms more quickly. Topical antimicrobials or antibiotics such as acetic acid, aminoglycosides, polymyxin B, and quinolones are the treatment of choice in uncomplicated cases. Tenderness with movement of the tragus or pinna is a classic finding. Acute otitis externa presents with the rapid onset of ear canal inflammation, resulting in otalgia, itching, canal edema, canal erythema, and otorrhea, and often occurs following swimming or minor trauma from inappropriate cleaning. The acute form is caused primarily by bacterial infection, with Pseudomonas aeruginosa and Staphylococcus aureus the most common pathogens. Acute otitis externa is a common condition involving inflammation of the ear canal.
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