eMedicine Specialties > Emergency Medicine > Ear, Nose, & Throat

Otitis Externa: Differential Diagnoses & Workup

Author: Samuel Lee, MD, Resident Physician, Department of Emergency Medicine, Wayne State University School of Medicine, Detroit Receiving Hospital
Coauthor(s): Adam J Rosh, MD, Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital
Contributor Information and Disclosures

Updated: Aug 4, 2009

Differential Diagnoses

Foreign Bodies, Ear
Herpes Zoster
Herpes Zoster Oticus
Otitis Media
Pediatrics, Otitis Media

Other Problems to Be Considered

Chondritis
Cranial nerve palsy
Hearing loss
Wisdom tooth eruption
Intracranial abscess
Cavernous sinus thrombosis

Workup

Laboratory Studies

  • Gram staining and culture of the canal discharge is occasionally helpful, particularly when a fungal cause is suspected.
  • Acute otitis externa is a clinical diagnosis.

Imaging Studies

  • If the patient shows signs or symptoms of systemic toxicity or bony involvement, CT scanning of the temporal and mastoid bones is appropriate.

Other Tests

  • Adults with otitis externa may benefit from a blood glucose check or a urine dipstick test to evaluate for occult diabetes.

Procedures

  • Gentle cleaning with a soft plastic curette or a small Frazier suction tip may be performed. Irrigation with a mix of peroxide and warm water may be helpful in removing debris from the canal, but only if the tympanic membrane is intact. Any water instilled must be successfully removed to avoid worsening of the condition.
  • Wick placement (see Treatment section) may be needed to facilitate delivery of the prescribed medications.
  • Pneumatic otoscopy may be used to evaluate for otitis media.

More on Otitis Externa

Overview: Otitis Externa
Differential Diagnoses & Workup: Otitis Externa
Treatment & Medication: Otitis Externa
Follow-up: Otitis Externa
Multimedia: Otitis Externa
References
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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, Makabale RL, Conroy PJ, Wall GM, 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. Beers SL, Abramo TJ. Otitis externa review. Pediatr Emerg Care. Apr 2004;20(4):250-6. [Medline].

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

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

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Keywords

otitis externa, swimmer's ear, ear ache, ear infection, otitis externa treatment, otitis externa symptoms, external ear canal infection, external otitis, malignant external otitis, eczematous otitis externa, malignant otitis externa

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Contributor Information and Disclosures

Author

Samuel Lee, MD, 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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

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.

 
 
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