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Otitis externa

Overview
  • Definition: Inflammation or infection of the external auditory canal (ear canal).
Aetiology/ Risk Factors
  • Bacterial: Most commonly Pseudomonas aeruginosa and Staphylococcus aureus.
  • Fungal: Aspergillus or Candida species (less common).
  • Excessive moisture: Swimming (β€˜swimmer’s ear’), humid environments.
  • Trauma: Inserting objects (e.g., cotton swabs), scratching.
  • Eczema or dermatitis of the ear canal.
  • Chronic ear disease or middle ear surgery.
Clinical Features
  • Otorrhoea (ear discharge).
  • Pruritus (itching).
  • Pain, especially when the auricle is pulled.
  • Hearing loss or a feeling of fullness.
  • Erythema and swelling of the ear canal on otoscopic examination.
Investigations
  • Ear swab: For microbiology if fungal infection is suspected or not responding to treatment.
  • Otoscopy: To assess the ear canal and eardrum.
Management
  • Topical antibiotics: E.g., ofloxacin or gentamicin drops.
  • Topical corticosteroids: To reduce inflammation.
  • Analgesics: Paracetamol or NSAIDs for pain relief.
  • Avoidance of water in the ear.
  • Fungal infections: Topical antifungals like clotrimazole.
  • Cleaning of the ear canal may be required in severe cases.
Complications
  • Malignant otitis externa: Infection spreading to surrounding tissues; more common in diabetics and the immunocompromised.
  • Chronic otitis externa.
  • Cellulitis or abscess of the pinna.
Key Points
  • Avoiding moisture and trauma can prevent otitis externa.
  • Otitis externa typically presents with pain, discharge, and sometimes hearing loss.
  • Appropriate topical treatment often leads to resolution, but it’s crucial to assess for complications or resistant cases.

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