Otitis externa – What are the signs and symptoms, relevant dDx., sequelae, work up, and treatment options?

Otitis externa is a bacterial or fungal infection of the outer ear canal, commonly associated with swimming and use of devices that occlude the ear canal (hearing aids, headphones).

Sn. & Sx.:

• Otalgia, tragal tenderness
• Otorrhea
• Aural fullness
• Conductive hearing loss
• Swelling of erythema of the ear canal
• Postauricular lymphadenopathy

dDx.:

• Cerumen impaction
• Cholesteatoma
• Otitis (AOM, effusion)
• Tympanic membrane perforation
• Otosclerosis
• Tympanosclerosis
• Foreign body obstruction

Sequelae:

• Tympanic membrane perforation
• Cranial nerve palsy
• Necrotizing otitis externa (skull base osteomyelitis)

Work up:

• Otoscopic exam (pain < with movement of the auricle, traction of the pinna of pressure on the tragus)

Tx.:

• Topical acetic acid solution to acidify ear canal 
• Antibiotics*

*Aminoglycosides are contraindicated if tympanic membrane if perforated due to potential for ototoxicity

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This post was written by Omar Rifai