Acute otitis externa

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    Diffuse inflammation of the external ear canal, due to bacterial or fungal infection. Common precipitants of otitis externa are maceration, trauma of the ear canal or presence of a foreign body or dermatologic diseases (such as eczema, psoriasis).

     

    Clinical features

    • Ear canal pruritus or ear pain, often severe and exacerbated by motion of the pinna; feeling of fullness in the ear; clear or purulent ear discharge or no discharge
    • Otoscopy (remove skin debris and secretions from the auditory canal by gentle dry mopping (use a dry cotton bud or a small piece of dry cotton wool):
      • diffuse erythema and edema, or infected eczema, of the ear canal
      • look for a foreign body
      • if visible, the tympanic membrane is normal (swelling and pain very often prevent adequate visualization of the tympanic membrane)

    Treatment

    • Remove a foreign body, if present.
    • Treatment of pain: paracetamol PO (Chapter 1, Pain).
    • Local treatment:
      • Remove secretions from the auditory canal by gentle dry mopping (use a dry cotton bud or a small piece of dry cotton wool). Consider ear irrigation (0.9% sodium chloride, using a syringe) only if the tympanic membrane can be fully visualised and is intact (no perforation). Otherwise, ear irrigation is contra-indicated.
      • Apply ciprofloxacin ear drops in the affected ear(s) for 7 days:
        Children ≥ 1 year: 3 drops 2 times daily
        Adults: 4 drops 2 times daily