Acute otitis externa


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