Otitis externa

Otitis externa is a common reason for primary care attendance in the UK.

Causes of otitis externa include:

• infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal
• seborrhoeic dermatitis
• contact dermatitis (allergic and irritant)
• recent swimming is a common trigger of otitis externa

Features

• ear pain, itch, discharge
• otoscopy: red, swollen, or eczematous canal

The recommended initial management of otitis externa is:

• topical antibiotic or a combined topical antibiotic with a steroid
• if the tympanic membrane is perforated aminoglycosides are traditionally not used ^
  • (^ many ENT doctors disagree with this and feel that concerns about ototoxicity are unfounded)
• if there is canal debris then consider removal
• if the canal is extensively swollen then an ear wick is sometimes inserted

Second-line options include

• consider contact dermatitis secondary to neomycin
• oral antibiotics (flucloxacillin) if the infection is spreading
• taking a swab inside the ear canal
• empirical use of an antifungal agent