Outer Ear
Bacterial Otitis Externa I
Localized OE/Furuncle
- Staph infection of the hair follicle
- Usually single, may be multiple
- S/Sx: severe pain and tenderness, pain on
jaw movements, edema over mastoid (if
affect post. meatus), enlarged
periauricular LN
- Tx: early w/o abscess - systemic abx,
analgesics, local heat, 10% ichthammol
glycerine, early w/ abscess – i&d, if
recurrent exclude DM, pay attention to
nasal vestibules
Bacterial Otitis Externa II
Diffuse OE
- Diffuse inflammation of meatal skin which
may spread to involve pinna and
epidermal layer of the tympanic
membrane
Otomycosis
Candida (L) and Aspergillus (R)
- Seen in hot and humid countries
- Secondary fungal infections also seen in
topical antibiotic use in OE or OME
- S/Sx: intense itch, pain/discomfort,
watery discharge with musty odour and
ear blockage
- Tx: ear toilet, antifungals; nystatin for
candida, clotrimazole, povidone x1/52,
keep ears dry
Herpes Zoster Oticus
- Formation of vesicles on the tympanic
membrane, meatal skin, concha and
postauricular groove
- The VIIth and VIIIth CN may be involved
Outer Ear

- Two factors: trauma to meatal skin, Malignant Otitis Externa

invasion by pathogenic organism (S.
aureus, B. proteus, E.coli)
- Acute: hot burning sensation in the ear,
pain aggravated by jaw movement. Ear
oozes thin serous discharge which
inflamed and swollen. Collection of debris
and discharge accompanied with meatal
swelling leads to CHL.
- Tx: ear toilet, medicated wicks (abx
steroid prep), abx, analgesics - Causative organism: Pseudomonas
- Chronic: irritation and strong desire to -
itch causing- acute exacerbations and
reinfection. Discharge is scanty and may
dry up to form scaling and fissuring.
Rarely, skin becomes hypertrophic leading
to meatal stenosis (chronic stenotic otitis
externa).
- Tx: medicated gauze wick, ear toilet,
topical abx steroid cream, CSOE- surgical