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).
– 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)
– 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