Otitis externa

associated with swimming; retained foreign objects

s/s - itching and discharge; tenderness when tragus is manipulated

Causal organisms include Pseudomonas aeruginosa (most common cause), Staph. aureus (2nd most common), E. coli, Proteus vulgaris, coagulase-negative Staph, diphtheroids, Micrococcus spp., and viridans streptococci.

NO routine culture

The recommended initial management of otitis externa is:

• topical antibiotic (ofloxacin, ciprofloxacin, or polymyxin/neomycin) or a combined topical antibiotic with a steroid
• if the tympanic membrane is perforated aminoglycosides are traditionally not used*
• if there is canal debris then consider removal
• if the canal is extensively swollen then an ear wick is sometimes inserted

Consider adding acetic acid and water solution to reacidify the ear

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

If a patient fails to respond to topical antibiotics then the patient should be referred to ENT.

Malignant otitis externa

It is actually an osteomyelitis of the skull