1. Overview of otitis externa
Anita Sonsale
Walsall Manor Hospital
Jan 2015

2. Objectives Pathogenesis Predisposing factors Principles of treatment
Current evidence

3. Classification Acute localised otitis externa- furuncle
Acute diffuse otitis externa- commonly bacterial
Chronic otitis externa
Eczematous otitis externa
Fungal otitis externa
Necrotising/ malignant otitis externa

4. 45 year old lady comes with right ear pain with itching and discharge
45 year old lady comes with right ear pain with itching and discharge. She has just returned from holiday in Cyprus.

5. Pathophysiology Superficial infection of EAC
Obstruction- cerumen, narrow EAC, exostosis EAC, hearing aid
Trauma
PH alteration
Role of PH of external auditory canal in acute otitis externa. Kumar S,Indian j head and neck surgery 2014, Jan 66(1):86-91

6. Predisposing factors Trauma Wet/ humid Skin conditions- eczema,
psoriasis

7. Bacterial Pseudomonas aeruginosa- commonest Staphylococcus species
Gram negative
Anaerobes

9. Fungal
Aspergillus
Candida

12. Diffuse otitis externa
Spreading
Resistant
May have evidence of chondritis

14. Principles of treatment
Topical treatment in uncomplicated OE-
Suction
Analgesics
Keeping ear dry
Ear swabs - only in resistant/ chronic OE

15. Ear swab
Only if condition does not improve with empirical topical treatment
OE is recurrent
After ear surgery
Infection beyond EAC
BMJ 2014 Llor, McNulty et al

16. A study of acute otitis externa at Wellington hospital , Jayakar, Sanders, Jones Australasian Med J 2014

17. History of previous ear problem-?perforation State of ear canal
Choice of ear drops
History of previous ear problem-?perforation
State of ear canal
If the swab results available
Cost
Sofradex ear drops- £ VAT
Gentisone HC ear drops- £4.76+VAT
Cipro- £4.70+VAT
Otomise ear spray- £3.50+ VAT
Locartan vioform ear drops- £1.76+ VAT

18. Delivery of ear drops
Narrow EAC
Use of Pope wick

19. Pitfalls
Necrotising OE
Malignancy - SCC
Exostosis

21. Post head injury- fracture temporal bone, facial palsy
AOM
Mastoiditis-
Post head injury- fracture temporal bone, facial palsy