OTITIS EXTERNA

Dr Masoud
 Otitis externa
• Otitis externa is an inflammation of the external
auditory meatus (EAM).
• can be divided according to the cause as follows;
a. Infectious otitis eterna
• Circumscript otits externa ( furuncle).
• Diffuse otitis externa.
• Malignant otitis externa.
b. Reactive otitis externa
. Eczematous otitis externa.
. Seborrhoeic otitis externa.
 Circumscript otitis externa.

• This infection affects the outer one third of the ear

canal.
• Normally presents with painful boils and
furuncles(due to infection of hair follicle).
• When boils ripe burst and the ear discharges pus.

Causes:
• Staphylococcus aureus, Pseudomonas aeruginosa.

Symptoms & signs:

• Pain - out of proportion to the visible lesion.
• Swelling - hyperemic skin.
• Hearing impairment - due to meatal occlusion by
the furuncle.

Treatment.
• Antibiotics, Analgesics depending with severity,
Incision and drainage.
Diffuse otitis externa.
• An inflammation of the entire external ear canal.
• Results to oedema and blockage of the
canal( commonly referred to as "swimmer's ear“).
• The causative organisms are initially fungi
(Aspegillus fumigatus, Aspegillus nigra and
Candida albicans).
• May complicate by mixed bacterial superinfection
like Staphylococcus aureus and Pseudomonas
aeuruginosa.
Predisposing factors:
 Skin laceration.
 Self inflicted.
 Ear wash or instruments.

 Hot humid atmosphere.

 Swimming.
 Discharge of chronic
suppurative Otitis media.
Symptoms.
• Itching.
• Discharges (scanty).
• Pain (usually moderate, sometimes
severe, increased by jaw movement).
• Hearing loss.
Signs.
• Meatal oedema.
• Moist debris, often smelly
• Red desquamated skin and oedema
of the meatal walls and often the
tympanic membrane.
• Otorrhoea.
Management of diffuse otitis externa.
• Ear swab - identification of the offending microorganism.
• Magnesium sulphate pack to reduce edema.
• Aural toilet - to clear the debris.
• Ear drops - antibiotic and steroid.
• Antifungal ear drops.

Prevention of recurrence.
• Prevent water entering the ears.
• Silicone rubber earplugs.
• Avoidance of scratching and poking the ears.
Otomycosis. …

Otomycosis is a fungal infection of the ear.

Predesposing factors.
• Moisture in the ear.
• Prolonged use of antibiotic ear drops.
• Immune supression.
Causative organisms.
• Aspergillus spp(commonest A.niger)
• Candida albicans.
Symptoms;
• Itching.
• Pain.
• Otorrhoea - brownish or blackish discharges.
• Deafness due to collection of discharge.
Signs.
• Early - cotton like growth.
• Late - wet newspaper like mass.
• Colour may be white in Candida
spp. and grey, brown or black in
Aspergillus spp).
Management.
• Ear swab for c/s.
• Antifungal ear drops for at least
two weeks.
• Cleaning of ear to remove debris.
• Antipruritic agents.
• Analgesics.
Malignant otitis externa.

• Is a progressive necrotising infection.

• starts in the external ear.
• involves tissues of the base of skull, temporal
bone and cranial nerves.
• Primarily occurs in immune suppressed people
eg. Elderly, diabetics, AIDS.
• Causative organism Pseudomonas aeruginosa.
Clinical features.
• Severe otalgia
• Granulation tissue protruding through the floor of
ear canal wall at the bone cartilaginous junction
• Extension to involve bone structures of temporal
bone, base of skull and intracranium.
• Cranial nerve VII paralysis.
• Can involve other cranial nerves at jugular
foramen.
• Intracranial spread present with headache, fever
neck stiffness and altered level of consciousness.
Investigation.
• Swab for culture and
sensitivity.
• CT scan-skull and the brain.
Treatment.
• Aggressive medical treatment.
• Antipseudomonas antibiotics
eg Ciprofloxacillin
intravenous for six weeks.
• Surgical debridment and
dressing.
Complications of malignant otitis externa.

• Osteomyelitis of the temporal bone and skull

base.
• Facial nerve paralysis at stylomastoid foramen.
• Last 4 cranial nerves paralysis at the jugular
foramen.
• Meningitis.
• Brain abscess.
• Septicaemia.
 Reactive otitis externa.
Eczematous otitis externa.
Is an allergic dermatitis of the external auditory
meatus.
Clinical features.
• Irritation and oedema of the canal.
• Weeping eczema with crusting occurs in
chronic cases.
• Secondary infection may lead to acute otitis
externa.
• Canal stenosis due to oedema and fibrosis.
• Fissuring and scalling.
Treatment
• Topical steroids.
• Antibiotics locally
and systematically.
• Antihistamines.

Squamous debris covering

the skin of the external
auditory canal can be
noted.
Seborrheic dermatitis.
• A chronic inflammatory skin disease.
• Unknown etiology with a predilection for areas of the skin rich with
sebaceous glands.
• Affection of the ear is often distributed along the concha, scaphoid
region, EAC, and postauricular crease.
• Cause has been associated with Pityrosporum ovale and Malassezia
furfur

Clinical Findings.
• Greasy scales overlying erythematous.
• Often pruritic plaques.
• The distribution often involves the scalp, forehead, eyebrows,
glabella, and nasolabial folds.
• Scaling of the scalp is common.
• Superimposed infection and edema may also occur.
• Differential Diagnosis.
Seborrheic dermatitis may be confused
with atopic or psoriatic dermatitis, and
scaling within the EAC may be confused
with external otitis or otomycosis.

• Treatment:
• steroid with antibiotic ointment or
drops.
• Aural toilet.
• Ketoconazole shampoo.
THANKS