otitis externa

Question 1

causes of otitis externa

Answer 1

infection: bacterial (staph aureus, pseudomonas aeruginosa), or fungal
seborrhoeic dermatitis
contact dermatitis
recent swimming

Question 2

presentation of otitis externa

Answer 2

ear pain, itch, discharge
otoscopy: red, swollen, eczematous canal

Question 3

initial management of otitis externa

Answer 3

topical antibiotic or combined topical antibiotic and steroid
if TM is perforated: aminoglycosides NOT USED

Question 4

second line management of otitis externa

Answer 4

oral antibiotics (flucloxacillin) if infection is spreading
take a swab
empirical use of antifungal agent

Question 5

what is malignant otitis externa

Answer 5

uncommon type of otitis externa in immunocompromised people
commonly caused by pseudomonas aeruginosa
infection starts in soft tissues of external auditory meatus then progresses to involve soft tissues and bony ear canal

Question 6

key features in the history that suggest otitis externa

Answer 6

diabetes
severe otalgia
temporal headaches
purulent otorrhea
possibly dysphagia

Question 7

diagnosis of malignant otitis externa

Answer 7

CT scan

Question 8

treatment of malignant otitis externa

Answer 8

refer urgently to ENT
IV antibiotics to cover pseudomonal infections