Otitis Externa

Inflammation of the outer ear canal

Aetiology

  • Almost always infective but may simply be inflammatory (e.g. response to shampoo, ear drops)

Bacterial causes

  • Staph. aureus
  • Proteus spp.
  • Pseudomonas aeruginosa

Fungal causes

  • Aspergillus niger
  • Candida albicans

Common triggers

  • Water exposure
  • Cotton buds
  • Skin conditions

Clinical presentation

  • Redness and swelling of the skin of the ear canal
  • May be itchy (especially in the early stages)
  • Can become sore and painful
  • There may be a discharge, or increased amounts of ear wax
  • If the canal becomes blocked by swelling or secretions, hearing can be affected
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Management

  • Topical aural toilet
  • Swab to microbiology and prescription of antimicrobial reserved for unresponsive or severe cases (e.g. topical clotrimazole if fungal, gentamicin drops if bacterial)
    • More severe cases may require region systemic as well as topical antibiotics e.g. if cellulitis develops in the pinna or parotid region
  • In eczematous otitis externa use a steroid without antibiotic, as antibiotics may cause local sensitivity
  • General care advice for patient:
    • Keep water out of the ear
    • Avoid traumatising with e.g. cotton buds
    • Keep hearing aids out as much as possible
  • If the external ear canal is very oedematous a wick or dressing may be required to carry drops past the swollen skin
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