Otitis Externa Disease

BASICS

DESCRIPTION

Inflammation of the external auditory canal

Acute diffuse otitis externa - the most common form, an infectious process usually bacterial, occasionally fungal
Acute circumscribed otitis externa - synonymous with furuncle. Associated with infection of the hair follicle.
Chronic otitis externa - same as acute diffuse, but of longer duration (greater than 6 weeks)
Eczematous otitis externa - may accompany typical atopic eczema or other primary skin conditions
Necrotizing "malignant" otitis externa - an infection which extends into the deeper tissues adjacent to the canal. May include osteomyelitis and cellulitis. Rare in children.
System(s) affected: Skin/Exocrine
Genetics: N/A
Incidence/Prevalence in USA:
- Unknown; incidence is higher in the summer months
- Acute, chronic, and eczematous - common
- Necrotizing - uncommon
Predominant age: All ages
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Itching
Plugging of the ear
Otalgia
Periauricular adenitis
Erythematous canal
Purulent discharge
Eczema of pinna
Cranial nerve involvement (VII, IX–XII)

CAUSES

Acute diffuse otitis externa
- Traumatized external canal (e.g., from use of cotton tip swab)
- Bacterial infection - pseudomonas (67% cases); staphylococcus; streptococcus; gram negative rods
- Fungal infection - aspergillus (90% cases); Phycomycetes; Rhizopus; actinomyces; Penicillium; yeast
Chronic otitis externa
- Bacterial infection - Pseudomonas
Eczematous otitis externa (associated with primary skin disorder)
- Eczema
- Seborrhea
- Neurodermatitis
- Contact dermatitis
- Purulent otitis media
- Sensitivity to topical medications
Necrotizing otitis externa
- Invasive bacterial infection - Pseudomonas

RISK FACTORS

Acute and chronic otitis externa
- Traumatization of external canal
- Swimming
- Hot humid weather
- Use of a hearing aid
Eczematous
- Primary skin disorder
Necrotizing otitis externa in adults
- Elderly
- Diabetes mellitus
- Debilitating disease
Necrotizing otitis externa in children (rare)
- Leukopenia
- Malnutrition
- Diabetes mellitus
- Diabetes insipidus

DIAGNOSIS

LABORATORY

Gram stain and culture of canal discharge (occasionally helpful)
Drugs that may alter lab results: Antibiotic pretreatment
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Acute and chronic otitis externa - desquamation of superficial epithelium of external canal with infection
Eczematous otitis externa - pathologic findings consistent with primary skin disorder, secondary infection on occasion
Necrotizing otitis externa - vasculitis, thrombosis and necrosis of involved tissues; osteomyelitis

SPECIAL TESTS

N/A

IMAGING

Radiologic evaluation of deep tissues in necrotizing otitis externa

DIAGNOSTIC PROCEDURES

N/A

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient, except for resistant cases and necrotizing otitis externa

GENERAL MEASURES

Thorough cleansing of external canal
Narcotic analgesics
Antipruritic and antihistamines (eczematous form)
'Ear wick' (Pope) for nearly occluded ear canal

SURGICAL MEASURES

N/A

ACTIVITY

No restrictions

DIET

No restrictions

PATIENT EDUCATION

Discuss Prevention/Avoidance

FOLLOW UP

PREVENTION/AVOIDANCE

Avoid prolonged exposure to moisture
Utilize preventive antiseptics
Treat predisposing skin conditions
Eliminate self-inflicted trauma to canal
Diagnose and treat underlying systemic conditions

POSSIBLE COMPLICATIONS

Mainly a problem with necrotizing otitis externa. May spread to infect contiguous bone and CNS structures.
Acute otitis externa may spread to pinna causing a chondritis

EXPECTED COURSE AND PROGNOSIS

Acute otitis externa - rapid response to therapy with total resolution
Chronic otitis externa - with repeated cleansing and antibiotic therapy the majority of cases will resolve. Occasionally, surgical intervention is required for resistant cases.
Eczematous otitis externa - resolution will occur with control of the primary skin condition
Necrotizing otitis externa - can usually be managed with debridement and prolonged parenteral antibiotics. Recurrence rate is 100% when treatment is inadequate. Surgical intervention may be necessary in resistant cases or if there is cranial nerve involvement. Mortality rate is significant, probably secondary to the underlying disease.

MISCELLANEOUS

ASSOCIATED CONDITIONS

See Risk Factors

AGE-RELATED FACTORS

N/A
Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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