eMedicine Specialties > Pediatrics: Surgery > Otolaryngology

Otitis Externa: Differential Diagnoses & Workup

Author: Ariel A Waitzman, MD, FRCS(C), Assistant Professor of Otolaryngology, Wayne State University
Contributor Information and Disclosures

Updated: Nov 24, 2009

Differential Diagnoses

Otitis Media

Other Problems to Be Considered

Ear canal trauma
Temporomandibular Joint Syndrome
Ear canal foreign body
Ear canal carcinoma
Otitis media with a perforation or ventilation tube present

Workup

Laboratory Studies

  • Most persons with otitis externa (OE) are treated empirically.
  • A culture taken from the ear canal discharge may be helpful in individuals with OE that is not responding to the usual measures.

Imaging Studies

  • Imaging studies are only performed in persons with suspected necrotizing OE (ie, malignant).
  • Classically, radionucleotide bone scan and gallium scan have been used to make the diagnosis.
  • Currently, high-resolution CT scanning of the temporal bone plays a more important role.
  • Although MRI has not been used to the same extent as these other tests, MRI may also be useful.

Procedures

  • Use of an ear wick helps topical medication penetrate a severely swollen ear canal.
  • The wick may be commercially prepared from a hard sponge material that expands when wet (eg, Merocel ear wick, Pope Oto-Wick), cut from a bigger sponge by the physician, or made from a narrow packing gauze.
  • The wick is placed in the ear canal (unfortunately, this causes brief but significant discomfort) and is moistened with topical antibiotic eardrops.
  • The ear wick usually is removed after 2-3 days.

More on Otitis Externa

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

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Keywords

otitis externa, OE, necrotizing otitis externa, NOE, malignant otitis externa, swimmer's ear, cellulitis, Pseudomonas aeruginosa, Staphylococcus aureus, Candida, Aspergillus, otalgia, lymphadenitis, hearing loss, tinnitus

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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 Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, Michigan State Medical Society, and Ontario Medical Association
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

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

 
 
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