Otitis externa

Swimmer’s ear.

Involves the external auditory canal as an infectious or inflammatory disease.

Affects 4 of every 1000 people with 10% developing the infection at some time during their life.

In 2007 an estimated 2.4 million visits with this diagnosis, 8.1 visits per 1,000 population.

Annual rates highest among children aged 5-9 years.

Incidence peaks during summer months.

Moistness in the external ear canal causes changes in the local pH and causes bacterial overgrowth.

S aureus or P aeruginosa infection is the most common cause of acute otitis externa.

Symptoms include pain, tenderness, redness drainage, swelling of the canal, and conductive hearing loss.

Occasionally associated with purulent exudate.

Associated with water exposure, and warm, humid environments.

Divided into acute and chronic processes.

Acute process usually secondary to a bacterial infection.

In a meta-analysis of 19 trials topical antibiotics, antiseptics, glucocorticoids, and acidifying agents were equally effective.

Topical antibiotic treatment is the treatment of choice.

Cure rate for acute otitis externa treated with topical anabiotics administered for 7-10 days ranges from 65-90%.

Chronic type associated with multiple etiologies including infection, inflammation and dermatopathology.

Simple otitis external caused by fungi 10% of the time, most commonly Aspergillus niger.

Malignant otitis externa when caused by fungus reflects an immunocompromised host.

Treatment includes improved ear canal toilet, and antibiotic ear drops.

Systemic antibiotics usually not indicated unless infection complicated by cellulitis of the surrounding skin, or other conditions such as immunosuppression or diabetes is present.

Malignant otitis externa an invasive infection of the external auditory canal which extends into soft tissues, cartilage, temporal bone and base of skull.

Malignant otitis externa most often caused by Pseudomonas aeruginosa.

Malignant otitis externa-treatment includes debridement and antimicrobial therapy.

Can be a rapidly fatal process without appropriated treatment.

Prevention measures include reduction in exposure of the ears to water using ear plugs, swim caps and using alcohol based ear drying solutions.

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