OTITIS

EXTERNA
TEMIDAYO ABASS
OUTLINE
● Definition
● Anatomy
● Epidemiology
● Classification
● Aetiology
● Clinical Presentation
● Investigation
● Treatment
● Complications
DEFINITION
●Otitis externa (OE) is an inflammation or
infection of the external auditory canal (EAC),
the auricle, or both.
ANATOMY OF THE EXTERNAL EAR
●The external ear consists of the auricle and the
EAC.
●Skin-lined apparatus
●Approximately 2.5 cm in length
●Ends at tympanic membrane
ANATOMY OF THE EXTERNAL EAR

●Auricle is mostly skin-lined cartilage

●External auditory meatus
- Cartilage: ~40%, Bony: ~60%
-S-shaped, Narrowest portion at bony-cartilage
junction
ANATOMY CONTINUED
●EAC is related to various contiguous structures
- Tympanic membrane
- Mastoid
- Glenoid fossa
- Cranial fossa
- Infratemporal fossa
ANATOMY CONTINUED
●Innervation: cranial nerves V, VII, IX, X, and
greater auricular nerve
●Arterial supply: superficial temporal, posterior and
deep auricular arteries
●Venous drainage: superficial temporal and
posterior auricular veins
EPIDEMIOLOGY
●Although the infection can affect all age groups,
OE appears to be most prevalent in the older
pediatric and young adult population, with a peak
incidence in children aged 7-12 years

●It affects both sexes equally.

●No racial predilection has been established.

CLASSIFICATION OF OTITIS EXTERNA
○It is commonly classified based on duration
1. Acute otitis externa
This is the most common form of OE, typically seen in
swimmers; it is characterized by rapid onset (generally
within 48 hours) and symptoms of EAC inflammation 

2. Chronic otitis externa

This is the same as acute OE but is of longer duration
(>6 weeks).
OTHERS
●Eczematous (eczematoid) OE – This encompasses various
dermatologic conditions ( atopic dermatitis, psoriasis, systemic
lupus erythematosus, and eczema) that may infect the EAC and
cause OE.

●Necrotizing (malignant) OE – This is an infection that extends

into the deeper tissues adjacent to the EAC; it primarily occurs in
adult patients who are immunocompromised.
AETIOLOGY
●OE is most often caused by a bacterial pathogen;   The most
common causative bacteria are Pseudomonas species (38% of all
cases), Staphylococcus species, and anaerobes and gram-negative
organisms.

● Fungal OE is caused by Aspergillus 80-90% of the

time; Candida and other organisms have also been isolated.
CONTRIBUTING FACTORS
●Absence of cerumen
●High humidity
●Retained water in ear canal
●Increased environmental temperature
●Local trauma (eg, use of cotton sensor hearing aids)
 Clinical Presentation
HISTORY

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

●Otalgia, ranging from mild to severe, typically progressing over 1-
2 days
●Hearing loss
●Ear fullness or pressure
●Tinnitus
●Fever (occasionally)
●Itching (especially in fungal OE or chronic OE)
 Clinical Presentation
HISTORY

●Severe deep pain – If this is experienced by a patient who is

immunocompromised or diabetic, be alerted to the possibility of
necrotizing (malignant) OE
●Discharge – Initially, the discharge may be clear and odorless, but it
quickly becomes purulent and foul-smelling
●Bilateral symptoms (rare)
●Frequently, a history of exposure to or activities in water (eg, swimming,
surfing, and kayaking)
●Usually, a history of preceding ear trauma (eg, forceful ear cleaning, use
of cotton swabs, or water in the ear canal)
CLINICAL PRESENTATION
EXAMINATION
The key physical finding of OE is pain upon palpation of the
tragus (anterior to ear canal) or application of traction to the
pinna (the hallmark of OE). Otoscopy reveals erythema,
edema, and narrowing of the external auditory canal (EAC),
and a purulent or serous discharge may be noted. Conductive
hearing loss may be evident. 
INVESTIGATION
●The patient’s history and physical examination usually provide
sufficient information to allow the clinician to make the diagnosis
of otitis externa (OE). Most persons with OE are treated
empirically.
●Thus, laboratory studies typically are not needed.
INVESTIGATION
●However, Gram staining and culture of any discharge from the
auditory canal may be helpful if the patient is
immunocompromised, if the usual treatment measures are
ineffective, or if a fungal cause is suspected. However, as many as
40% of all cases of OE do not produce a dominant pathogen.
●Adults with OE may benefit from a blood glucose check or a
urine dipstick test to evaluate for occult diabetes.
TREATMENT
●Primary treatment of otitis externa (OE) involves management of
pain, removal of debris from the external auditory canal (EAC),
administration of topical medications to control edema and
infection, and avoidance of contributing factors.
●Most cases can be treated with over-the-counter analgesics and
topical eardrops. Commonly used eardrops include acetic acid
drops, which change the pH of the ear canal; antibacterial drops,
which control bacterial growth; and antifungal preparations.
TREATMENT
●In severe cases, oral or intravenous (IV) antibiotic
therapy and narcotic analgesics may be required. 
●In the case of necrotizing (malignant) OE, the patient
must be admitted to a hospital for IV antibiotic therapy
at the discretion of the consulting
otorhinolaryngologist.
COMPLICATIONS
Complications of OE are rare and may include the following:
● Necrotizing OE (the most significant complication)
● Mastoiditis
● Chondritis of the auricle (from spread of acute OE to the pinna,
particularly in patients with newly pierced ears)
● Bony erosion of the base of the skull (skull base osteomyelitis)
● Central nervous system (CNS) infection
● Cellulitis or lymphadenitis
CONCLUSION
● With a thorough history and physical examination, diagnosis of otitis
externa can be made and treated appropriately.
REFERENCES
● Ahmed AlMumtin MD. OTITIS EXTERNA PRESENTATION. SLIDESHARE.
● Ariel A Waitzman, MD, FRCSC. OTITIS EXTERNA. MEDSCAPE.
THANK YOU