Pediatric Otitis Externa Clinical Presentation

  • Author: Ariel A Waitzman, MD, FRCS(C); Chief Editor: Glenn C Isaacson, MD, FACS, FAAP   more...
 
Updated: Apr 2, 2012
 

History

Patients with otitis externa (OE) may complain of the following:

  • Otalgia ranging from mild to severe
  • Hearing loss
  • Ear fullness or pressure
  • Tinnitus
  • Fever (occasionally)
  • Ear discharge
  • Itch (especially in fungal infections or chronic OE)
  • Severe deep pain (If experienced by a patient who is immunocompromised or diabetic, be alerted to the possibility of necrotizing OE.)
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Physical

Characteristics of OE present upon physical examination may include the following:

  • Pain upon palpation of the tragus (anterior to ear canal) or when applying traction to the pinna (hallmark of OE)
  • Edema and redness of the ear canalAcute otitis externa. The ear canal is red and edeAcute otitis externa. The ear canal is red and edematous, and discharge is present.
  • Purulent or serous discharge in the ear canal
  • Conductive hearing loss
  • Cellulitis of the face or neck or lymphadenopathy of the unilateral neck (in some patients)
  • Fungal OE characteristics include the following:
    • Fungal infections result in severe itch but less pain than bacterial OE.
    • A thick discharge that may be white or gray is often present.
    • Upon close examination, the discharge may have visible fungal elements or a fuzzy appearance.
  • Necrotizing (malignant) OE characteristics include the following:
    • The sine qua non of necrotizing OE is pain out of proportion to clinical findings.
    • Upon close examination, granulation tissue may be present in the ear canal.
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Causes

Risk factors for OE include swimming (hence, the commonly used term swimmer's ear), any source of water trapped in the ear canal, trauma to the ear canal, and a hot humid environment.

  • Causative organisms for OE: These are usually Pseudomonas species, S aureus, or other gram-negative organisms.
  • Fungal OE
    • Fungal OE may result from overtreatment of the ear canal with topical antibiotics, or it occasionally may present de novo from moisture trapped in the ear canal.
    • The most common organisms involved with fungal OE are Candida and Aspergillus species; however, many others have been isolated.
  • Chronic OE
    • Chronic OE is a fairly common condition that may be the result of incomplete treatment of acute OE.[2]
    • However, chronic OE more often is caused by overmanipulation of the ear canal due to cleaning and scratching.
    • This results in a low-grade inflammatory response that further causes itching of the skin.
    • Eventually the skin thickens, and canal stenosis may occur.
  • Necrotizing OE: Necrotizing OE occurs in patients who are immunocompromised and represents a true osteomyelitis of the temporal bone.
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Contributor Information and Disclosures
Author

Ariel A Waitzman, MD, FRCS(C)  Assistant Professor of Otolaryngology, Wayne State University

Ariel A Waitzman, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, and Michigan State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Orval Brown, MD  Director of Otolaryngology Clinic, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas

Orval Brown, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Medical Association, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

John E McClay, MD  Associate Professor of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Dallas, University of Texas Southwestern Medical School

John E McClay, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Medical Association

Disclosure: Nothing to disclose.

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Glenn C Isaacson, MD, FACS, FAAP  Professor of Otolaryngology-Head and Neck Surgery and Pediatrics, Temple University School of Medicine

Glenn C Isaacson, MD, FACS, FAAP is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society of Pediatric Otolaryngology, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Covidien Honoraria Consulting

References

  1. Rowlands S, Devalia H, Smith C, et al. 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].

  2. Roland PS. Chronic external otitis. Ear Nose Throat J. Jun 2001;80(6 Suppl):12-6. [Medline].

  3. Benjamin B, Bingham B, Hawke M. A Colour Atlas of Otorhinolaryngology. London, UK: Martin Dunitz Ltd; 1995.

  4. Bluestone CD, Klein JO. Otitis Media in Infants and Children. Philadelphia, PA: WB Saunders; 1988.

  5. Hawke M, Jahn AF. Diseases of the Ear: Clinical and Pathologic Aspects. Philadelphia, PA: JB Lippincott Co; 1988.

  6. Hawke M, Keene M, Alberti PW. Clinical Otoscopy: An Introduction to Ear Diseases. Edinburgh, UK: Churchill Livingstone; 1990.

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

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

  9. Tierney PA, Price T, Gillet D. Improving standards in the treatment of acute otitis externa by the use of a treatment protocol and open access to aural toilet. J Laryngol Otol. Feb 2001;115(2):87-90. [Medline].

  10. Waitzman AA, Hawke, M. Otoscopic examination: what to look for in the external ear. Consultant. 1996;36(5).

  11. Walshe P, Rowley H, Timon C. A worrying development in the microbiology of otitis externa. Clin Otolaryngol. Jun 2001;26(3):218-20. [Medline].

 
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Acute otitis externa. The ear canal is red and edematous, and discharge is present.
 
 
 
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