Otitis externa encompasses various inflammatory conditions of the external auditory meatus, classified into infectious, reactive, and seborrheic types. Symptoms include pain, swelling, hearing impairment, and in severe cases, necrotizing infections affecting the skull bases and cranial nerves. Treatment varies based on the type and severity of infection, often involving antibiotics, antifungals, and surgical intervention for complications.

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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