Otitis Externa
ENT Dx
ENT Ex
OE = inflammation of the ear canal
Etiology
Bacteria (Staph aureus, Pseudomonas, Strep. pyogenes)
Fungi (white blotting paper debris or black spores)
Dermatitis
Foreign Body
Trauma
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Acute diffuse OE (aka swimmers ear)
microorganism grow promoted by:
erythema, swelling, pruritus, swelling
small, white clumpy discharge
usually Pseudomonas aeruginosa
Rx
ear toilet
lie on side
IN NON-PERFORATED DRUM
NO-fungal signs > Sofradex/Otadex review in 48 hours
Fungal OR no improvement in 48 hours > Otocomb/Kenacomb/Locacorten
3 drops 3 times a day for 3-7 days (Locacorten is BD)
FOR PERFORATED DRUM
ciproxin (no sign of fungal) or Locacorten (if signs of fungal)
if no narrowing direct to ear canal > pump tragus for 30s > stay on side for 3 mins > review in 48 hours if not improving
if narrowing > use ear wick > review in 24 hours
Keep ear dry during and for 2 weeks post treatment
i.e. cotton wool balls smeared in vaseline during showers/baths, no swimming
Prevention of recurrence ONCE healed
- avoid local trauma
- earplugs during showering and swimming
- if perforation > acetic acid drops
- no perforation > acetic acid plus isopropyl alcohol ear drops following exposure to water; instil 4 to 6 drops into each ear after shaking the water out
----
Acute localised otitis externa
i.e. cellulitis, folliculitis (Staph), erysipelas (Strep)
pinna or outer ⅓ of canal (ie hair containing and cartilage underlying)
usually Staph aureus
cephalexin 12.5mg/kg (max 500mg) PO q6h for 5 days
Immediate hypersensitivity to penicillins > clindamycin 10mg/kg (max 450mg) PO q8h for 5 days
Surgical consult if fluctuant
----
Chronic OE
Scaly erythematous dermatitis ?OM with perf. DDx psoriasis, atopic or seborrhoeic dermatitis.
----
Necrotising (aka malignant aka invasive) OE (Pseudomonas aeruginosa)
spread to cartilage, OM of base of skull > meningitis
usually in DM or immunocompromised
Treatment failure (fever, severe pain, granulation, CN neuropathy)
ENT/ID consult
Tazocin and Gentamicin
Immediate pen hypersensitivity > Ciprofloxacin and Gentamicin
ENT Ex
OE = inflammation of the ear canal
Etiology
Bacteria (Staph aureus, Pseudomonas, Strep. pyogenes)
Fungi (white blotting paper debris or black spores)
Dermatitis
Foreign Body
Trauma
-------------------------------------------------
Acute diffuse OE (aka swimmers ear)
microorganism grow promoted by:
- presence of water (swimming/humitity)
- loss of cerumen
- increased pH
erythema, swelling, pruritus, swelling
small, white clumpy discharge
usually Pseudomonas aeruginosa
Rx
ear toilet
lie on side
IN NON-PERFORATED DRUM
NO-fungal signs > Sofradex/Otadex review in 48 hours
Fungal OR no improvement in 48 hours > Otocomb/Kenacomb/Locacorten
3 drops 3 times a day for 3-7 days (Locacorten is BD)
FOR PERFORATED DRUM
ciproxin (no sign of fungal) or Locacorten (if signs of fungal)
if no narrowing direct to ear canal > pump tragus for 30s > stay on side for 3 mins > review in 48 hours if not improving
if narrowing > use ear wick > review in 24 hours
Keep ear dry during and for 2 weeks post treatment
i.e. cotton wool balls smeared in vaseline during showers/baths, no swimming
Prevention of recurrence ONCE healed
- avoid local trauma
- earplugs during showering and swimming
- if perforation > acetic acid drops
- no perforation > acetic acid plus isopropyl alcohol ear drops following exposure to water; instil 4 to 6 drops into each ear after shaking the water out
----
Acute localised otitis externa
i.e. cellulitis, folliculitis (Staph), erysipelas (Strep)
pinna or outer ⅓ of canal (ie hair containing and cartilage underlying)
usually Staph aureus
cephalexin 12.5mg/kg (max 500mg) PO q6h for 5 days
Immediate hypersensitivity to penicillins > clindamycin 10mg/kg (max 450mg) PO q8h for 5 days
Surgical consult if fluctuant
----
Chronic OE
Scaly erythematous dermatitis ?OM with perf. DDx psoriasis, atopic or seborrhoeic dermatitis.
----
Necrotising (aka malignant aka invasive) OE (Pseudomonas aeruginosa)
spread to cartilage, OM of base of skull > meningitis
usually in DM or immunocompromised
Treatment failure (fever, severe pain, granulation, CN neuropathy)
ENT/ID consult
Tazocin and Gentamicin
Immediate pen hypersensitivity > Ciprofloxacin and Gentamicin