eMedicine Specialties > Pediatrics: Surgery > Otolaryngology

Otitis Externa: Follow-up

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

Updated: Mar 14, 2008

Follow-up

Further Outpatient Care

  • Monitor patients to ensure complete resolution. Usually a follow-up visit one week after starting treatment is adequate.

Deterrence/Prevention

Some patients acquire otitis externa (OE) multiple times and should use a preventive strategy.

  • Earplugs worn for swimming and bathing are effective. Wipe earplugs with rubbing alcohol after use.
  • Acidifying drops placed in the ear after swimming or bathing also have a prophylactic benefit.

Complications

  • Complications of OE are rare. As mentioned, cellulitis or lymphadenitis may occur and should be treated with an oral antibiotic therapy.

Prognosis

  • Most incidents of OE resolve without difficulty.
  • Pain usually improves 2-5 days after initiating therapy.
  • Most incidents of OE resolve in 7-10 days.
  • In some patients with OE, the ear must be debrided prior to full resolution.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize necrotizing (ie, malignant) otitis externa (OE) is a significant pitfall. A patient who is diabetic or immunocompromised with severe pain in the ear should have necrotizing OE excluded by an otolaryngologist.
  • Although rare, malignant tumors of the ear canal sometimes are misdiagnosed as OE. If the condition does not respond to treatment as expected, an otolaryngologist should evaluate the patient.
  • Use of aminoglycoside antibiotic eardrops in the presence of a perforation or ventilation tube may cause problems. Although this is controversial, many otolaryngologists believe that aminoglycoside eardrops may be ototoxic if they enter the middle ear. In this situation, using an alternative such as quinolone drops may be safer.
 


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.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

John E McClay, MD, Assistant Professor, Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's Medical Center, 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

Maureen Strafford, MD, Arnold P Gold Foundation Associate Professor, Departments of Anesthesiology and Pediatrics, Tufts University and Tufts-New England Medical Center
Maureen Strafford, MD is a member of the following medical societies: American Medical Women's Association, American Pain Society, American Society of Anesthesiologists, International Anesthesia Research Society, Society for Education in Anesthesia, Society for Pediatric Anesthesia, and Society of Cardiovascular Anesthesiologists
Disclosure: Nothing to disclose.

 
 
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