Otitis Externa in Emergency Medicine Follow-up

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

Further Outpatient Care

Patients may follow up with an otorhinolaryngologist (ENT) physician.

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Deterrence/Prevention

  • Patients who have recurrent episodes of otitis externa should be taught to use acidifying drops in their ears after every exposure to water to prevent recurrences.
  • Attention to elimination of water after swimming or bathing may help prevent recurrence. The use of a blow dryer on a low setting after swimming to dry the ear canal has been suggested as a preventive measure. No studies have demonstrated the effectiveness of this suggestion.
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Complications

  • Malignant otitis externa is the only significant complication.
    • Most frequently, the disease occurs in diabetic and immunocompromised patients and involves bacterial spread to the cartilage of the external ear with resulting pain and edema.
    • It may be accompanied by a fever and systemic manifestations of infection.
    • Treatment requires parenteral antibiotics with coverage for Pseudomonas species, in addition to local care.
    • These patients require specialty consultation and hospitalization.
  • Acute otitis externa may spread to the pinna, resulting in a chondritis, particularly in patients with newly pierced ears.
  • Diabetic ketoacidosis is often present in diabetics with this condition.
  • Herpes zoster may initially present with symptoms similar to otitis externa, and vesicular eruption may occur 1-2 days after the initial symptoms. Ramsey Hunt syndrome is a rare complication of herpes zoster and presents with peripheral unilateral facial palsy. Patients should be counseled on this possible presentation and advised to seek medical care if it occurs.[6]
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Prognosis

  • Most patients with otitis externa improve within 48-72 hours of antibiotic administration.
  • Failure to improve within 2-3 days should call the diagnosis into question and prompt the physician to reevaluate the patient.
  • Surgical intervention is sometimes necessary for chronic otitis externa.
  • Resolution of eczematous otitis externa occurs with control of the primary skin condition.
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Patient Education

  • Prevention by using acidifying drops is encouraged in patients with recurrent episodes of otitis externa.
  • Avoidance of cotton-tipped swabs to avoid ear canal trauma should be discussed with patients. Improper use of cotton-tipped applicator sticks simply packs cerumen into the canal and can cause trauma to the tympanic membrane.
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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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