A brief explanation on the most common pathology affecting the ear on daily clinical practice Which is an otitis externa

1. OTITIS EXTERNA
Dr Masoud
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2. Otitis externa
• Otitis externa is an inflammation of the external
auditory meatus (EAM).
• can be divided according to the cause as follows;
a. Infectious otitis eterna
• Circumscript otits externa ( furuncle).
• Diffuse otitis externa.
• Malignant otitis externa.
b. Reactive otitis externa
. Eczematous otitis externa.
. Seborrhoeic otitis externa.
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3. Circumscript otitis externa.
• This infection affects the outer one third of the ear
canal.
• Normally presents with painful boils and
furuncles(due to infection of hair follicle).
• When boils ripe burst and the ear discharges pus.
Causes:
• Staphylococcus aureus, Pseudomonas
aeruginosa.
Symptoms & signs:
• Pain - out of proportion to the visible lesion.
• Swelling - hyperemic skin.
• Hearing impairment - due to meatal occlusion by
the furuncle.
Treatment.
• Antibiotics, Analgesics depending with severity,
Incision and drainage.
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4. Diffuse otitis externa.
• An inflammation of the entire external ear
canal.
• Results to oedema and blockage of the canal(
commonly referred to as "swimmer's ear“).
• The causative organisms are initially fungi
(Aspegillus fumigatus, Aspegillus nigra and
Candida albicans).
• May complicate by mixed bacterial
superinfection like Staphylococcus aureus and
Pseudomonas aeuruginosa. 4

5. Predisposing factors:
 Skin laceration.
 Self inflicted.
 Ear wash or instruments.
 Hot humid atmosphere.
 Swimming.
 Discharge of chronic
suppurative Otitis media.
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6. Symptoms.
• Itching.
• Discharges (scanty).
• Pain (usually moderate, sometimes
severe, increased by jaw movement).
• Hearing loss.
Signs.
• Meatal oedema.
• Moist debris, often smelly
• Red desquamated skin and oedema
of the meatal walls and often the
tympanic membrane.
• Otorrhoea.
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7. Management of diffuse otitis externa.
• Ear swab - identification of the offending microorganism.
• Magnesium sulphate pack to reduce edema.
• Aural toilet - to clear the debris.
• Ear drops - antibiotic and steroid.
• Antifungal ear drops.
Prevention of recurrence.
• Prevent water entering the ears.
• Silicone rubber earplugs.
• Avoidance of scratching and poking the ears.
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8. …
Otomycosis.
Otomycosis is a fungal infection of the ear.
Predesposing factors.
• Moisture in the ear.
• Prolonged use of antibiotic ear drops.
• Immune supression.
Causative organisms.
• Aspergillus spp(commonest A.niger)
• Candida albicans.
Symptoms;
• Itching.
• Pain.
• Otorrhoea - brownish or blackish discharges.
• Deafness due to collection of discharge.
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9. Signs.
• Early - cotton like growth.
• Late - wet newspaper like mass.
• Colour may be white in Candida
spp. and grey, brown or black in
Aspergillus spp).
Management.
• Ear swab for c/s.
• Antifungal ear drops for at least
two weeks.
• Cleaning of ear to remove debris.
• Antipruritic agents.
• Analgesics.
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10. Malignant otitis externa.
• Is a progressive necrotising infection.
• starts in the external ear.
• involves tissues of the base of skull, temporal
bone and cranial nerves.
• Primarily occurs in immune suppressed people
eg. Elderly, diabetics, AIDS.
• Causative organism Pseudomonas aeruginosa.
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11. Clinical features.
• Severe otalgia
• Granulation tissue protruding through the floor of
ear canal wall at the bone cartilaginous junction
• Extension to involve bone structures of temporal
bone, base of skull and intracranium.
• Cranial nerve VII paralysis.
• Can involve other cranial nerves at jugular foramen.
• Intracranial spread present with headache, fever
neck stiffness and altered level of consciousness.
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12. Investigation.
• Swab for culture and
sensitivity.
• CT scan-skull and the brain.
Treatment.
• Aggressive medical treatment.
• Antipseudomonas antibiotics
eg Ciprofloxacillin
intravenous for six weeks.
• Surgical debridment and
dressing.
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13. Complications of malignant otitis externa.
• Osteomyelitis of the temporal bone and skull
base.
• Facial nerve paralysis at stylomastoid foramen.
• Last 4 cranial nerves paralysis at the jugular
foramen.
• Meningitis.
• Brain abscess.
• Septicaemia.
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14. Reactive otitis externa.
Eczematous otitis externa.
Is an allergic dermatitis of the external auditory
meatus.
Clinical features.
• Irritation and oedema of the canal.
• Weeping eczema with crusting occurs in chronic
cases.
• Secondary infection may lead to acute otitis
externa.
• Canal stenosis due to oedema and fibrosis.
• Fissuring and scalling.
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15. Treatment
• Topical steroids.
• Antibiotics locally
and systematically.
• Antihistamines.
Squamous debris covering
the skin of the external
auditory canal can be
noted.
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16. Seborrheic dermatitis.
• A chronic inflammatory skin disease.
• Unknown etiology with a predilection for areas of the skin
rich with sebaceous glands.
• Affection of the ear is often distributed along the concha,
scaphoid region, EAC, and postauricular crease.
• Cause has been associated with Pityrosporum ovale and
Malassezia furfur
Clinical Findings.
• Greasy scales overlying erythematous.
• Often pruritic plaques.
• The distribution often involves the scalp, forehead, eyebrows,
glabella, and nasolabial folds.
• Scaling of the scalp is common.
• Superimposed infection and edema may also occur.
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17. • Differential Diagnosis.
Seborrheic dermatitis may be confused
with atopic or psoriatic dermatitis, and
scaling within the EAC may be
confused with external otitis or
otomycosis.
• Treatment:
• steroid with antibiotic ointment or
drops.
• Aural toilet.
• Ketoconazole shampoo.
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18. THANKS
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