Otitis externa

Otitis externa is a common reason for primary care attendance in the UK.

• infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal
• seborrhoeic dermatitis
• contact dermatitis (allergic and irritant)
• recent swimming is a common trigger of otitis externa

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

• topical antibiotic or a combined topical antibiotic with a steroid
• if the tympanic membrane is perforated aminoglycosides are traditionally not used*
• if there is canal debris then consider removal
• if the canal is extensively swollen then an ear wick is sometimes inserted

• consider contact dermatitis secondary to neomycin
• oral antibiotics (flucloxacillin) if the infection is spreading
• taking a swab inside the ear canal
• empirical use of an antifungal agent

If a patient fails to respond to topical antibiotics then the patient should be referred to ENT.

Malignant otitis externa is more common in elderly diabetics. In this condition, there is extension of infection into the bony ear canal and the soft tissues deep to the bony canal. Intravenous antibiotics may be required.

*many ENT doctors disagree with this and feel that concerns about ototoxicity are unfounded