Otitis Externa

Question 1

Otitis Externa:

Risk factors to consider and why?

Answer 1

Diabetics, elderly and immunocompromised individuals due to increased risk for otomycosis and necrotising otitis externa

Question 2

Otitis Externa:

Most common pathogens bacterial or fungal?

Answer 2

• Pseudomonas aeruginosa and Staphylococcus aureus

- Candida or Aspergillus

Question 3

Otitis Externa:

standard management?

Answer 3

KEEP EAR DRY

• rolled tissue spears 6 times day, leave in for 3 - 5 minutes (https://www.youtube.com/watch?v=joymXXYoOZw&vl=en)
• apply ear drops (steroid plus antibiotic or antifungal -based on suspected pathogen) after drying (wriggle tragus to dissipate drops)
• if canal swollen a wick can be inserted to allow delivery of drops deeper into canal
• remain dry for 2 weeks post treatment

Question 4

Otitis Externa:

Alternative management?

Answer 4

<4% Boric acid preparations often combined with alcohol

Question 5

Otitis Externa:

Prevention?

Answer 5

• Avoid water exposure

- use acetic acid plus isopropyl alcohol drops after water exposure (Aquaear $10 OTC)

Question 6

Otitis Externa:

When to consider necrotising otitis externa as a diagnosis?

Answer 6

• no response to treatment
• fever
• severe persistent pain
• visible granulation tissue
• progressive cranial neuropathies

Question 7

Otitis Externa:

Managment of necrotising otitis externa?

Answer 7

• swab

- IV antibiotics in hopsital