eMedicine Specialties > Sports Medicine > Face and Head

Otitis Externa: Differential Diagnoses & Workup

Author: Joseph P Garry, MD, FACSM, FAAFP,, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise and Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
Coauthor(s): Sanjiv K Bhalla, MD, Consulting Staff, Department of Emergency Medicine, St Paul's Hospital of Vancouver, St Joseph's Hospital of Hamilton
Contributor Information and Disclosures

Updated: Nov 30, 2007

Differential Diagnoses

Facial Soft Tissue Injuries

Other Problems to Be Considered

Barotrauma (in the Emergency Medicine section) (See also Barotrauma and Mechanical Ventilation [in the Pulmology section].)

Dysbarism

Foreign Bodies, Ear (in the Emergency Medicine section) (See also Foreign Body Removal, Ear, [in the Clinical Procedures section].)

Herpes Zoster (in the Infectious Diseases section) (See also the eMedicine articles Postherpetic Neuralgia [in the Neurology section], Herpes Zoster [in the Emergency Medicine section], and Herpes Zoster [in the Dermatology section].)

Mastoiditis (in the Emergency Medicine section) (See also Mastoiditis [in the Pediatrics section].)

Otitis Media

Ramsay Hunt Syndrome

Workup

Laboratory Studies

  • The patient's history and physical examination usually provide adequate information to make the diagnosis of otitis externa.
  • Typically, laboratory studies are not needed in the diagnosis of otitis externa. However, Gram stain and culture of any discharge from the auditory canal may be helpful if the patient is immunocompromised, treatment is failing, or if a fungal cause is suspected. However, up to 40% of all cases of otitis externa do not produce a dominant pathogen.

Imaging Studies

  • Radiologic investigation may be helpful if an invasive infection is suspected or if the diagnosis of mastoiditis is being considered. Computed tomography (CT) scanning is preferred and better depicts bony erosion.10 A magnetic resonance imaging (MRI) study may be considered secondarily or if soft-tissue extension is the predominant concern. (See also the eMedicine articles Mastoiditis [in the Pediatrics section], Mastoiditis [in the Emergency Medicine section], and Middle Ear, Mastoiditis [in the Otolaryngology and Facial Plastic Surgery].)

More on Otitis Externa

Overview: Otitis Externa
Differential Diagnoses & Workup: Otitis Externa
Treatment & Medication: Otitis Externa
Follow-up: Otitis Externa
References
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References

  1. Bojrab DI, Bruderly T, Abdulrazzak Y. Otitis externa. Otolaryngol Clin North Am. Oct 1996;29(5):761-82. [Medline].

  2. Cantor RM. Otitis externa and otitis media. A new look at old problems. Emerg Med Clin North Am. May 1995;13(2):445-55. [Medline].

  3. 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].

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

  5. Russell JD, Donnelly M, McShane DP, Alun-Jones T, Walsh M. What causes acute otitis externa?. J Laryngol Otol. Oct 1993;107(10):898-901. [Medline].

  6. Holten KB, Gick J. Management of the patient with otitis externa. J Fam Pract. Apr 2001;50(4):353-60. [Medline]. [Full Text].

  7. Rowlands S, Devalia H, Smith C, Hubbard R, Dean A. Otitis externa in UK general practice: a survey using the UK General Practice Research Database. Br J Gen Pract. Jul 2001;51(468):533-8. [Medline]. [Full Text].

  8. Hughes E, Lee JH. Otitis externa. Pediatr Rev. Jun 2001;22(6):191-7. [Medline].

  9. Clark WB, Brook I, Bianki D, Thompson DH. Microbiology of otitis externa. Otolaryngol Head Neck Surg. Jan 1997;116(1):23-5. [Medline].

  10. Grandis JR, Curtin HD, Yu VL. Necrotizing (malignant) external otitis: prospective comparison of CT and MR imaging in diagnosis and follow-up. Radiology. Aug 1995;196(2):499-504. [Medline]. [Full Text].

  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].

  12. Caffier PP, Harth W, Mayelzadeh B, Haupt H, Sedlmaier B. Tacrolimus: a new option in therapy-resistant chronic external otitis. Laryngoscope. Jun 2007;117(6):1046-52. [Medline].

  13. Bath AP, Walsh RM, Bance ML, Rutka JA. Ototoxicity of topical gentamicin preparations. Laryngoscope. Jul 1999;109(7 pt 1):1088-93. [Medline].

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

  15. Rosen P, Barkin RM, Hayden SR, Schaider JJ, Wolfe R. Otitis externa. The 5 Minute Emergency Medicine Consult. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999:796-7.

  16. Tintinalli JE, Kelen GD, Stapczynski JS, eds. Emergency Medicine: A Comprehensive Study Guide. 5th ed. New York, NY: McGraw-Hill Professional Publishing; 2000:1521-3.

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Further Reading

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Keywords

swimmer's ear, acute diffuse otitis externa, acute localized otitis externa, necrotizing otitis externa, eczematous otitis externa, infection of the external auditory canal

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Contributor Information and Disclosures

Author

Joseph P Garry, MD, FACSM, FAAFP,, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise and Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
Joseph P Garry, MD, FACSM, FAAFP, is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, and North American Primary Care Research Group
Disclosure: Nothing to disclose.

Coauthor(s)

Sanjiv K Bhalla, MD, Consulting Staff, Department of Emergency Medicine, St Paul's Hospital of Vancouver, St Joseph's Hospital of Hamilton
Sanjiv K Bhalla, MD is a member of the following medical societies: American College of Emergency Physicians, British Columbia Medical Association, Canadian Association of Emergency Physicians, Canadian Medical Association, Canadian Medical Protective Association, and Ontario Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Andrew L Sherman, MD, MS, Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, Leonard A Miller School of Medicine, University of Miami
Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, American Medical Association, American Paraplegia Society, American Spinal Injury Association, and Association of Academic Physiatrists
Disclosure: pfizer Honoraria Speaking and teaching

Pharmacy Editor

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

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa
Disclosure: Nothing to disclose.

 
 
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