The document is a clinical presentation on otitis externa, detailing its types, diagnosis, treatment options, and complications. A case study is included of a 30-year-old male patient experiencing right earache, with diagnostic evaluations and management plans discussed. Various types of otitis externa are explained, including infective and reactive groups, with emphasis on different treatment strategies for conditions like furuncle, otomycosis, and allergic reactions.

1. OTITIS EXTERNA
DR AWAIS IRSHAD
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2. LEARNING OBJECTIVES
 WHAT IS OTITIS EXTERNA & IT’S TYPE
 TREATMENT OF DIFFERENT TYPES OF OE
 DIAGNOSTIC EVALUATION AND HISTORY TAKING
 COMPLICATIONS AND DIFFERENTIAL DIAGNOSIS
 MANAGEMENT & PREVENTION
 PRESCRIPTION OF PROBABLE DIAGNOSIS
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3. A 30 YEARS OLD MALE PATIENT PRESENTED IN ENT CLINIC
WITH A COMPLAIN OF RIGHT EARACHE FOR LAST 2 DAYS.
THE PAIN IS AGGRAVATED ON CHEWING OF FOOD AND
DURING SPEECH. ON EXAMINATION OF RIGHT EAR,
PRESSURE ON THE TRAGUS IS PAINFUL AND THERE IS
SMALL RED SWELLING ARISING FROM THE ANTERIOR
WALL OF EXTERNAL AUDITORY CANAL WHICH IS
PARTIALLY OCCLUDING THE CANAL WITH NO DISCHARGE
IN RIGHT EAR. LEFT EAR EXAMINATION IS NORMAL.
RENNIE’S TEST IS NEGATIVE IN RIGHT EAR AND POSITIVE
IN LEFT EAR, WEBER TEST LATERALIZES TOWARDS RIGHT
EAR.
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4. OTITIS EXTERNA
Otitis externa is a
condition that causes
inflammation (redness and
swelling) of the external
ear canal, which is the
tube between the outer ear
and eardrum.
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5. DIVISION OF OTITIS EXTERNA
Otitis externa may be divided into two main group
1. INFECTIVE GROUP
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6. 2. Reactive Group
Eczematous otitis externa
Seborrheic otitis externa
Neurodermatitis
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7. (A) FURUNCLE (LOCALIZED
ACUTE OTITIS EXTERNA)
A FURUNCLE IS A STAPHYLOCOCCAL
INFECTION OF THE HAIR FOLLICLE.
AS THE HAIR ARE CONFINED ONLY
TO THE CARTILAGINOUS PART OF
THE MEATUS, FURUNCLE IS SEEN
ONLY IN THIS PART OF MEATUS
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8. SEVERE PAIN
TENDERNESS
MOVEMENTS OF THE PINNA ARE PAINFUL
JAW MOVEMENTS, AS IN CHEWING, ALSO CAUSE PAIN IN THE
EAR.
A FURUNCLE OF POSTERIOR MEATAL WALL CAUSES OEDEMA
OVER THE MASTOID WITH OBLITERATION OF THE GROOVE
RETROAURICULAR.
PREAURICULAR LYMPH NODES MAY ALSO BE ENLARGED AND
TENDER
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PRESENTING COMPLAIN

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TREATMENT
 In early cases, systemic antibiotics, analgesics and local
heat
 10% ichthammol glycerine provides splintage and reduces
pain
 Hygroscopic action of glycerine reduces oedema
 ichthammol is mildly antiseptic.
 If abscess has formed, incision and drainage should be
done.
 In case of recurrent furunculosis, diabetes should be
excluded, and attention paid to the patient’s nasal
vestibules which may harbour staphylococci and the
infection transferred by patient’s fingers.

10. It is diffuse inflammation of meatal skin which may spread to involve the pinna
and epidermal layer of tympanic membrane . Disease is commonly seen in hot
and humid climate and in swimmers
ACUTE PHASE
 hot burning sensation
 thin serous discharge
 cellulitis
CHRONIC PHASE
 IRRITATION
 ITCHING
 Discharge is scanty and may dry up to form crusts, meatal stenosis
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b) Diffuse otitis externa

11. (C) OTOMYCOSIS
 Otomycosis. Otomycosis is a fungal infection of the
ear canal that often occurs due to Aspergillus niger,
or Candida albicans.
 PRESENTING COMPLAIN:
 watery discharge with a musty odour
 ITICHING
 EAR BLOCKAGE
 fungal mass may appear white, brown or black
 TREATMENT
 ear toilet to remove all discharge and epithelial debris
debris which are conducive to the growth of fungus.
 It can be done by syringing, suction or mopping
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Nystatin (100,000 units/mL of propylene glycol) is
effective against Candida

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(D) OTITIS EXTERNA HAEMORRHAGICA
 It is characterized by formation of haemorrhagic
bullae on the tympanic membrane and deep
meatus.
 blood-stained discharge when the bullae rupture
 Treatment with analgesics is directed to give
relief from pain. Antibiotics are given for
secondary infection of the ear canal, or middle ear
if the bulla has ruptured into the middle ear.

13. (E) HERPES ZOSTER OTICUS
IT IS CHARACTERIZED BY FORMATION OF VESICLES ON
THE TYMPANIC MEMBRANE, MEATAL SKIN, CONCHA AND
POSTAURICULAR GROOVE. THE VII AND VIII CRANIAL
NERVES MAY BE INVOLVED.
(F) MALIGNANT (NECROTIZING) OTITIS EXTERNA.
IT IS AN INFLAMMATORY CONDITION CAUSED BY
PSEUDOMONAS INFECTION USUALLY IN THE ELDERLY
DIABETICS, OR IN THOSE ON IMMUNOSUPPRESSIVE
DRUGS.
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14. 2. REACTIVE GROUP
(A) ECZEMATOUS OTITIS EXTERNA
CAUSE: IT IS RESULT OF HYPERSENSITIVITY TO INFECTIVE
ORGANISMS OR TOPICAL EAR DROPS SUCH AS CHLOROMYCETIN OR
NEOMYCIN, ETC.
CLINICAL FEATURES: IT IS MARKED BY INTENSE IRRITATION,
VESICLE FORMATION, OOZING AND CRUSTING IN THE CANAL.
TREATMENT: IS WITHDRAWAL OF TOPICAL ANTIBIOTIC CAUSING
SENSITIVITY AND APPLICATION OF STEROID CREAM
(B) SEBORRHOEIC OTITIS EXTERNA
IT IS ASSOCIATED WITH SEBORRHOEIC DERMATITIS OF THE SCALP.
CLINICAL FEATURES: ITCHING IS THE MAIN COMPLAINT. GREASY
YELLOW SCALES ARE SEEN IN THE EXTERNAL CANAL, OVER THE
LOBULE AND POSTAURICULAR SULCUS.
TREATMENT: CONSISTS OF EAR TOILET, APPLICATION OF A CREAM
CONTAINING SALICYLIC ACID AND SULFUR, AND ATTENTION TO
THE SCALP FOR SEBORRHOEA.
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15. (C) NEURODERMATITIS.
CAUSE: IT IS CAUSED BY COMPULSIVE SCRATCHING
DUE TO PSYCHOLOGICAL FACTORS.
CLINICAL FEATURES: PATIENT'S MAIN COMPLAINT IS
INTENSE ITCHING. OTITIS EXTERNA OF BACTERIAL
TYPE MAY FOLLOW INFECTION OF RAW AREA LEFT BY
SCRATCHING.
TREATMENT: IS SYMPATHETIC PSYCHOTHERAPY AND
THAT MEANT FOR ANY SECONDARY INFECTION.
EAR PACK AND BANDAGE TO THE EAR ARE HELPFUL TO
PREVENT COMPULSIVE SCRATCHING.
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18. A 30 YEARS OLD MALE PATIENT PRESENTED IN ENT CLINIC WITH A
COMPLAIN OF RIGHT EARACHE FOR LAST 2 DAYS. THE PAIN IS
AGGRAVATED ON CHEWING OF FOOD AND DURING SPEECH. ON
EXAMINATION OF RIGHT EAR, PRESSURE ON THE TRAGUS IS PAINFUL
AND THERE IS SMALL RED SWELLING ARISING FROM THE ANTERIOR
WALL OF EXTERNAL AUDITORY CANAL WHICH IS PARTIALLY OCCLUDING
THE CANAL WITH NO DISCHARGE IN RIGHT EAR. LEFT EAR EXAMINATION
IS NORMAL. RENNIE’S TEST IS NEGATIVE IN RIGHT EAR AND POSITIVE IN
LEFT EAR, WEBER TEST LATERALIZES TOWARDS RIGHT EAR.
1. WHAT SPECIFIC QUESTION YOU WOULD ASK IN HISTORY TO AID AND ELICIT THE
DIAGNOSIS?
2. GIVE YOUR DIFFERENTIAL DIAGNOSIS.
3. GIVE MANAGEMENT PLAN OF MOST PROBABLE DIAGNOSIS.
4. WHAT TYPE OF HEARING LOSS IS PRESENT ON THE BASIS OF TUNING FORK TEST?
5. WHAT COMPLICATION CAN OCCUR IN THIS PATIENT?
6. WRITE THE PRESCRIPTION FOR THE PROBABLE
DIAGNOSIS?
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COMPLICATION AND PREVENTION

23. PRESCRIPTION OF PROBABLE DIAGNOSIS
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