CASE PRESENTATION

SUPERVI SOR:
DR. OSCAR DJAUHARI , SP. THT

PRESENTED BY:
VI CTOR BANDANA 201 2. 061 . 049
GESTANO 201 2. 061 . 054

Otitis Externa
Ear Nose Throat - Head and Neck Department
Medical Faculty of Unika Atma Jaya Jakarta
Syamsudin, S.H. Regional General Hospital,
Sukabumi
Period September 22nd 2014 October 18th 2014
PATIENTS IDENTITY

Name : Mr. M
Gender : Male
Age : 35 years old
Occupation : Bussinessman
Race : Javanese
Address : Sukabumi
Weight : 65 kg
Height : 170 cm
HISTORY
Chief Complaint :
Severe right ear pain.

Additional Complaint :
Right ear fullness, fluid came out from right ear, mild decreased
hearing.

History of Present Illness
A 35-years-old male came to ENT clinic with a chief complaint of
rapid-onset severe right ear pain and fullness. The patient complains
of otorrhea and mild decreased hearing in the right ear. He reports
that his symptoms started after swimming 2 days ago. No fever is
reported.
HISTORY
History of Past Illness
History of previous illness was denied

History of Family Illness
History of family illness was denied

PHYSICAL EXAMINATION

General condition : Appear calm
Body weight : 65 kg
Height : 170 cm
Blood pressure :
120
/
80
mmHg
Pulse : 88 beats per minute
Respiratory rate : 20 times per minute
Temperature : 36,9
o
C

ENT Examination
Ear
Right ear
Auricle : normal
External auditory canal :
hyperemic (+), edema (+), mass (-), laceration (-) secretion (-),
cerumen (-), pain on tragus (+)
Tymphanic membrane :
Cant visualized due to the swelling
Left ear
Auricle : normal
External auditory canal:
hyperemic (-), edema (-), mass (-), laceration (-) secretion (-) ,
cerumen (-)
Tymphanic membrane:
Intact, bulging (-), light reflex (+)

Otoscopy Right Ear
Nose
Right nose
Mucous membrane:
hyperemic (-), edema (-), ,mass (-), laceration (-), crust (-)
Inferior conchae : eutrophy
Septum : no deviation
Air passage : normal
Left nose
Mucous membrane:
hyperemic (-), edema (-),secretion (-), mass (-), laceration (-), crust (-)
Inferior conchae : eurtrophy
Septum : no deviation
Air passage :normal
ENT Examination
Oropharynx
Posterior pharynx : hyperemic (-)
Palatine tonsils : T1 / T1, hyperemic (-), detritus (-)
Uvula : symmetrical
Dental : no abnormatlities

Maxillofacial : symmetrical

Neck : no lymphadenopathy
ENT Examination
WORKING DIAGNOSIS
, 35 years old with Acute Otitis Eksterna AD


DIFFERENTIAL DIAGNOSIS
Trauma
Tumor

WORK-UP
Laboratory:
Complete blood count
TREATMENT
Cleansing with 2% acetic acid
Topical Antibiotic
Analgetic
Education for aural toilet
LITERATURE REVIEW
Otitis externa commonly infection (usually
bacterial, occasionally fungal)

May associated noninfectious systemic or local
dermatologic processes

Characteristic symptom :
Discomfort, limited to the CAE
Erythema and swelling of the canal with variable discharge
Definition

Otitis externa is an infection of the outer ear canal.

Also called swimmer's ear.

Anatomy and Physiology of the External
Auditory Canal

Precipitants and Etiology of Otitis
Externa

Moisture
- Swimming
- Perspiration
- High humidity
Water contaminated with
bacteria
High environmental
temperatures
Mechanical removal of
cerumen



Insertion of foreign objects
- Cotton swabs
- Fingernails
- Hearing aids
- Ear plugs
Other trauma to ear canal
Chronic dermatologic
disease
- Eczema
- Psoriasis
- Seborrheic dermatitis
- Acne

Etiology

The most common cause OE bacterial infection

Fungal overgrowth 10 percent of cases
BACTERIAL OTITIS EXTERNA
Overview
External auditory canal

Normal bacterial flora

Remains free of infection

Defenses disrupted

New pathogenic flora develops

Dominated by Pseudomonas aeruginosa & Staphylococcus
aureus.
BACTERIAL OTITIS EXTERNA
OE with a bacterial etiology more intense than
other

Otalgia may be severe enough to require systemic
analgesics such as codeine and nonsteroidal anti-
inflammatory drugs (NSAIDs)

Significant swelling of the canal is common
BACTERIAL OTITIS EXTERNA
Once the external auditory canal has been cleansed
as much as possible and a wick inserted if swelling is
severe, topical antibacterial therapy should be
started.

Topical agents acidification with 2 % acetic acid
usually effective

Steroids ear drops inflammation & edema
resolve symptoms more quickly
Clinical Presentation
Otalgia
Otorrhea
Itching
Swelling in ear canal
Crusting around the ear canal opening.
Sometimes swelling or pus may decrease hearing
Diagnosis
Cause Characteristic
Otitis Externa
Acute bacterial Scant white mucus, but occasionally thick
Chronic bacterial Bloody discharge, especially in the presence of granulation tissue
Fungal Typically fluffy and white to off-white discharge, but may be black,
gray, bluish-green or yellow; small black or white conidiophores on
white hyphae associated with Aspergillus
Otitis media with perforated tympanic membrane
Acute Purulent white to yellow mucus with deep pain
Serous Clear mucus, especially in the presence of allergies
Chronic Intermittent purulent mucus without pain
Cerebrospinal fluid
leak
Clear, thin and watery discharge
Trauma Bloody mucus
Osteomyelitis Otorrhea with odor
Treatment
Prevention of Recurrence

Avoiding precipitants

Treat any underlying chronic dermatologic disorders
Otitis Externa Maligna
Diabetes most significant risk factor
(90% of patients)

50% of cases of malignant external otitis (MEO)
preceded by traumatic aural irrigation in patients
with diabetes.
Physical examination
Inflammatory changes
The pain is out of proportion
Marked tenderness is present in the soft tissue
between the mandible ramus and mastoid tip
Granulation tissue is present at the floor of the
osseocartilaginous junction
Otoscopic examination may also reveal exposed bone
The cranial nerves (V-XII) should be examined
Mental status examination
Fever is uncommon
Laboratory Studies
Leukocyte count

Erythrocyte sedimentation rate

Serum chemistry

Culture and sensitivities from the external auditory
canal
Imaging Studies
CT scanning and MRI

For evaluating the anatomic extent of soft tissue
inflammation, abscess formation, and intracranial
complications
Treatment
Treatment includes :
meticulous glucose control
aural toilet
systemic and ototopic antimicrobial therapy