Otitis Externa in Emergency Medicine Clinical Presentation

  • Author: Samuel Lee, MD, MS; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Apr 20, 2010
 

History

  • In general, a history of 1-2 days of progressive ear pain
  • Frequently, a history of exposure to or activities in water, such as swimming, surfing, and kayaking
  • Pruritus within the ear canal
  • Purulent discharge
  • Conductive hearing loss
  • Feeling of fullness or pressure
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Physical

  • The sine qua non of otitis externa is pain on gentle traction of the external ear structures.
  • Periauricular adenitis may occur but is not necessary for the diagnosis.
  • Examination of the canal reveals erythema, edema, and narrowing of the external auditory canal.
  • Typically, accumulation of moist debris is observed in the external canal.
  • The tympanic membrane may be difficult to visualize and may be mildly inflamed, but it should be normally mobile on insufflation.
  • Spores and hyphae may be seen in the external canal if the etiology is fungal.
  • Eczema of the pinna may be present.
  • By definition, cranial nerve (CN) involvement (ie, of CNs VII and IX-XII) is not associated with simple otitis externa.
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Causes

  • Traumatized external canal (particularly due to cotton-tipped swabs)
  • Bacterial infection
    • Pseudomonas species (38% of all cases)[1]
    • Staphylococcus species
    • Gram-negative rods
  • Fungal infection (rare, 10%) -Aspergillus species
  • Yeast (rare) -Candida species
  • Eczematous otitis externa
    • Eczema
    • Seborrhea
    • Neurodermatitis
    • Contact dermatitis from earrings or hearing aid use
    • Purulent otitis media with perforation of the tympanic membrane and drainage (This may mimic findings in otitis externa, but it is usually painless and has no swelling of the canal.)
    • Sensitivity to topical medications
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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Samuel Lee, MD, MS  Resident Physician, Department of Emergency Medicine, Wayne State University School of Medicine, Detroit Receiving Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD  Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital

Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerry Balentine, DO  Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St. Barnabas Hospital

Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Mark W Fourre, MD  Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Roland PS, Stroman DW. Microbiology of acute otitis externa. Laryngoscope. Jul 2002;112(7 Pt 1):1166-77. [Medline].

  2. Osguthorpe JD, Nielsen DR. Otitis externa: Review and clinical update. Am Fam Physician. Nov 1 2006;74(9):1510-6. [Medline].

  3. Wall GM, Stroman DW, Roland PS, Dohar J. Ciprofloxacin 0.3%/dexamethasone 0.1% sterile otic suspension for the topical treatment of ear infections: a review of the literature. Pediatr Infect Dis J. Feb 2009;28(2):141-4. [Medline].

  4. [Guideline] Rosenfeld RM, Brown L, Cannon CR, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. Apr 2006;134(4 Suppl):S4-23. [Medline]. [Full Text].

  5. Roland PS, Belcher BP, Bettis R, et al. A single topical agent is clinically equivalent to the combination of topical and oral antibiotic treatment for otitis externa. Am J Otolaryngol. Jul-Aug 2008;29(4):255-61. [Medline].

  6. Kim D, Bhimani M. Ramsay Hunt syndrome presenting as simple otitis externa. CJEM. May 2008;10(3):247-50. [Medline].

  7. Beers SL, Abramo TJ. Otitis externa review. Pediatr Emerg Care. Apr 2004;20(4):250-6. [Medline].

  8. Block SL. Otitis externa: providing relief while avoiding complications. J Fam Pract. Aug 2005;54(8):669-76. [Medline].

  9. Niparko JK. Hearing loss and associated problems. In: Principles of Ambulatory Medicine. 4th ed. Lippincott Williams & Wilkins; 1995:1408-9.

  10. Rahman A, Rizwan S, Waycaster C, Wall GM. Pooled analysis of two clinical trials comparing the clinical outcomes of topical ciprofloxacin/dexamethasone otic suspension and polymyxin B/neomycin/hydrocortisone otic suspension for the treatment of acute otitis externa in adults and children. Clin Ther. Sep 2007;29(9):1950-6. [Medline].

  11. Rosenfeld RM, Singer M, Wasserman JM, Stinnett SS. Systematic review of topical antimicrobial therapy for acute otitis externa. Otolaryngol Head Neck Surg. Apr 2006;134(4 Suppl):S24-48. [Medline].

 
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Otitis externa with ear wick in place. Note discharge from canal and swelling of canal.
 
 
 
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