Ear Disorders: Otitis Externa, Malignant Otitis Externa

– Ear Disorders –

Otitis Externa

Malignant Otitis Externa

Otitis Externa

More in young poeple —- r/t swimming, ear cleaning, moisture

Causative pathogens —- Bacterria, Virus, Fungus —- Pseudomonas a., Candida, Enterobacteriaceae, others

Hallmark S/S —- pain on tragus on palpation (pain on palpation = tenderness)

other S/S —- itching, erythematous, edematous, exudate, cerumen

Treatment —- topical ABT (mild case), oral ABT, there are more tx regimens.

ABT choice —- fluoroquinolone (ofloxacine, ciprofloxacin) —- covering causative pathogens empirically, safe to use for patients with non-intact TM.

Neomycin + Polymyxin B hydrocortisone (Cortisporin) – A/E: ototoxicity – can’t use if TM is not intact.

Irrigation is NOT recommended 

Acute Otitis Externa vs. Chronic Otitis Externa —- Chronic otitis externa S/S: severe itching, no cerumen, dry, excoriations due to scrathing to relieve itching.

Otitis Externa

Otitis Externa

Malignant Otitis Exgterna

More in older people —- diabetes, immunocompromised

Malignant otitis externa = Necrotizing otitis externa = Osteomyelitis of the ear

Most common causative pathogen —- P. aeruginosa

High risk population —- immunocompromised, Hx of skull radiotherapy, osteomyelitis of temporal bone

S/S —- severe pain, fever, facial paralysis, CN abnormality

Dx —- CT scan, redionucleotide bone scanning (detects malignant “bone” tumor), gallium scanning (detects cells that devide quickly = cancer cells)