Otitis Externa Follow-up

  • Author: Joseph P Garry, MD, FACSM, FAAFP; Chief Editor: Craig C Young, MD   more...
 
Updated: Feb 28, 2010
 

Further Outpatient Care

Follow-up is important in order to ascertain the patient's response to treatment for otitis externa. Even in mild cases, the patient should be reassessed 2-3 days following the initiation of treatment.

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Deterrence/Prevention

  • Several measures that are related to ear hygiene may be taken to help prevent recurrent otitis externa infections.
    • Eliminate any self-inflicted trauma to the ear canal, such as using cotton swabs or inserting objects into the external auditory canal.
    • Avoid frequent washing of the ears with soap, as this leaves an alkali residue that neutralizes the acidic pH of the ear canal.
    • Avoid swimming in polluted waters.
    • Ensure that the ear canals are emptied of water after swimming or bathing.
  • Prophylactic ear drops: A combination of a 2:1 ratio of 70% isopropyl alcohol and acetic acid may be used after each episode of swimming to assist in drying and acidifying the ear canal.
  • Generally, earplugs should be avoided due to the fact that these objects may cause trauma to the ear canal, thereby predisposing to the development of otitis externa.
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Complications

  • Complications of otitis externa include local purulent extension of disease, such as the following:
    • Necrotizing otitis externa
    • Mastoiditis
    • Chondritis of the auricle
    • Bony erosion of the base of the skull
    • Central nervous system (CNS) infection
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Prognosis

  • The patient may return to aquatic activities once the infection has been eradicated, generally within 4-5 days.
  • Aquatic athletes may return to the pool earlier than 4-5 days; however, they need to keep their ear canals dry. Generally, after 2-3 days of refraining from any water activity, the athlete can return to water activities but the head should be kept dry until the infection has been eradicated.
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Patient Education

  • Otitis externa is a common problem with risk factors that can be easily avoided. Prevention of this common medical condition for aquatic athletes is the most important advancement in the past decade. When otitis externa does strike, the condition can usually be resolved in a short time with few complications.
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Contributor Information and Disclosures
Author

Joseph P Garry, MD, FACSM, FAAFP  Associate Professor, Sports Medicine Faculty, Department of Family and Community Medicine, University of Minnesota Medical School

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.

Specialty Editor Board

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, University of Miami, Leonard A Miller School of Medicine

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 Medical Association, and Association of Academic Physiatrists

Disclosure: Pfizer Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Russell D White, MD  Professor of Medicine, Professor of Orthopedic Surgery, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, 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, Director of Primary Care Sports Medicine Fellowship, 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.

References

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  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].

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  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].

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  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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