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Otitis Externa
Last updated 10th October 2023
Presentation
- Discharge, itch, pain and tragal tenderness due to acute inflammation of the skin of the meatus, usually caused by excess canal moisture.
- Other causes: trauma eg: fingernails, cotton buds
- Most common organism: Pseudomonas and Staphylococcus
Otoscopic Examination
- Red, oedematous ear canal which may be narrowed and obscured by debris.
- Ear discharge (serous or purulent).
- Signs of fungal infection (such as white strands of Candida, or small black or white balls of Aspergillus).
- Regional lymphadenopathy.
- Cellulitis spreading beyond the ear
Treatment
- Swab for microbiology
- Topical antibiotics:
- Maxitrol/ Sofradex 5 drops BD or
- Otomize 2 sprays TDS or
- If pseudomonas suspected: Ciprofloxacin 5 drops BD or Gentisone HC 5 drops BD
- No water in ears
- Treatment is usually for 7-10 days.
- If associated with pinna/facial cellulitis, combined with oral antibiotics: flucloxacillin/ clarithromycin/ co-amoxiclav/ciprofloxacin.
- Fungal infection treatment:
- Clotrimazole 1% solution 5 drops BD for 2/52 or
- Acetic acid spray 2 sprays TDS
- If severe otitis externa: the ear canal is occluded – refer to ENT, ear wick needs to be inserted.
Links
-
- How should I assess a person with suspected otitis externa? – NICE February 2022
- Oxford Handbook of Clinical Specialties – Baldwin, Oxford Academic, 2020 page 392 [Can be accessed via Knowledge Network]
Content by Alexandra Barabas & Marissa Botma