Acute otitis externa

Condition

• Acute otitis externa

Definition 

• infection of the ear canal
• Common responsible organisms
• Bacteria
• Pseudomonas sp. 
• Escherichia coli
• S. aureus
• Proteus sp. 
• Klebsiella sp. 
• Fungi
• Candida albicans
• Aspergillus sp. 

Clinical features 

• Itching at first
• Pain (mild to intense)
• Fullness in ear canal
• Scant discharge
• Hearing loss

Signs

• Oedema 
• Tenderness on moving auricle or jaw
• Erythema 
• Discharge (offensive if coliform)
• Pale cream 'wet blotting paper' debris - C. albicans
• Black spores of aspergillum nigra 
• TM granular or dull red 

Management

• Keep ear canal as dry as possible 
• Remove discharge from the ear canal by aural toilet 6 hourly
• use sofradex or kenacomb 2-3 drops tads 
• pump the triages ( by pressing on it repeatedly without causing pain) for 30 seconds after instilling ear drops 
• Systemic antibiotic offers no benefits unless there are systemic symptoms
• Keep the ear dry during, and for 2 weeks after, treatment

Reference

• eTG
• John Murtagh's general practice 5th edition