eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > External Ear Diseases

External Ear, Infections: Follow-up

Author: Ashutosh Kacker, MD, Associate Professor of Otorhinolaryngology, Department of Otolaryngology, Weill College of Medicine of Cornell University; Consulting Staff, New York Presbyterian Hospital, New York Hospital of Queens
Contributor Information and Disclosures

Updated: Sep 17, 2009

Follow-up

Further Outpatient Care

The patient requires suctioning of the external auditory canal (EAC) on a weekly basis until debris has been removed.

Inpatient & Outpatient Medications

Topical eardrops are the mainstay of both inpatient and outpatient treatment. Oral antibiotics or antifungal agents are usually reserved for refractory cases.

Deterrence/Prevention

Otitis externa can be prevented by avoiding use of cotton-tipped swabs or objects such as bobby pins to clean ears. Use of cotton-tipped swabs or bobby pins can cause excoriation of the canal skin that can lead to otitis externa.

Prognosis

The prognosis of uncomplicated otitis externa is uniformly good. Patients with malignant otitis externa have a more guarded prognosis.

Patient Education

  • Educate patients to keep the ear dry and to refrain from the use of cotton-tipped swabs or home remedies, such as ear candles, to remove ear cerumen.
  • For excellent patient education resources, visit eMedicine's Ear, Nose, and Throat Center Center. Also, see eMedicine's patient education article Swimmer's Ear.

Miscellaneous

Medicolegal Pitfalls

Failure to diagnosis an EAC malignancy is a common pitfall associated with otitis externa. Refer patients with refractory otitis externa to an otolaryngologist for management and possible ear canal biopsy.

Special Concerns

Otitis externa in patients who are diabetic or immunocompromised can progress to skull base osteomyelitis.1

 


More on External Ear, Infections

Overview: External Ear, Infections
Differential Diagnoses & Workup: External Ear, Infections
Treatment & Medication: External Ear, Infections
Follow-up: External Ear, Infections
Multimedia: External Ear, Infections
References
Further Reading
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References

  1. Alva B, Prasad KC, Prasad SC, Pallavi. Temporal bone osteomyelitis and temporoparietal abscess secondary to malignant otitis externa. J Laryngol Otol. Apr 17 2009;1-4. [Medline].

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

  3. Brook I. Treatment of otitis externa in children. Paediatr Drugs. Oct-Dec 1999;1(4):283-9. [Medline].

  4. Mirza N. Otitis externa. Management in the primary care office. Postgrad Med. May 1996;99(5):153-4, 157-8. [Medline].

  5. Morden NE, Berke EM. Topical fluoroquinolones for eye and ear. Am Fam Physician. Oct 15 2000;62(8):1870-6. [Medline].

  6. Selesnick SH. Otitis externa: management of the recalcitrant case. Am J Otol. May 1994;15(3):408-12. [Medline].

  7. Tierney MR, Baker AS. Infections of the head and neck in diabetes mellitus. Infect Dis Clin North Am. Mar 1995;9(1):195-216. [Medline].

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Further Reading

Clinical guidelines
Rosenfeld RM, Brown L, Cannon CR, Dolor RJ, Ganiats TG, Hannley M, Kokemueller P, Marcy SM, Roland PS, Shiffman RN, Stinnett SS, Witsell DL, American Academy of Otolaryngology--Head and Neck Surgery Foundation. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg 2006 Apr;134(4 Suppl):S4-23. 2

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Keywords

external ear infections, ear infections, infections of the external ear, otitis externa, swimmer ear, swimmer's ear, malignant otitis externa, ear furuncle, external auditory canal, EAC, otomycosis, fungal otitis externa, eczematoid, psoriatic otitis externa, otorrhea, herpes zoster oticus

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Contributor Information and Disclosures

Author

Ashutosh Kacker, MD, Associate Professor of Otorhinolaryngology, Department of Otolaryngology, Weill College of Medicine of Cornell University; Consulting Staff, New York Presbyterian Hospital, New York Hospital of Queens
Ashutosh Kacker, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Rhinologic Society, and Triological Society
Disclosure: Nothing to disclose.

Medical Editor

Jack A Shohet, MD, Associate Clinical Professor, Department of Otolaryngology-Head and Neck Surgery, University of California Irvine; Otolaryngologist, Shohet Ear Associates Medical Group, Inc
Jack A Shohet, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Neurotology Society, American Tinnitus Association, and California Medical Association
Disclosure: Envoy Medical Consulting fee Consulting

Pharmacy Editor

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

Managing Editor

Gerard J Gianoli, MD, Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center
Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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