Otitis Externa Overview and Classification

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Questions and Answers

What symptom is least likely associated with otitis externa?

Erythema

Purulent discharge

Edema

Bilateral hearing loss (correct)

Which first-line agent is used for the treatment of otitis externa?

Nystatin

Amoxicillin

Dexamethasone

Ciprofloxacin-Hydrocortisone (correct)

Which condition is NOT part of the differential diagnosis for otitis externa?

Acute sinusitis (correct)

Cerumen impaction

Hearing loss

Furuncle

What is a hallmark sign of necrotizing external otitis?

Granulation tissue Signup and view all the answers

In patients with persistent symptoms of otitis externa, what should be the next step?

Reevaluate for treatment failure Signup and view all the answers

Which group is primarily at risk for developing necrotizing external otitis?

Older adults with diabetes mellitus Signup and view all the answers

What is the recommended duration for continuing treatment with topical medication for otitis externa if symptoms do not resolve?

One additional week Signup and view all the answers

Which of the following is NOT a common contributing factor for otitis externa?

Chronic respiratory infections Signup and view all the answers

What is the most common form of otitis externa?

Acute diffuse OE Signup and view all the answers

What could result from excessive cerumen buildup in the ear canal?

Moisture retention leading to infection Signup and view all the answers

Which type of otitis externa is specifically associated with dermatologic conditions?

Eczematous OE Signup and view all the answers

What characterizes chronic otitis externa?

Infection that is of longer duration than 6 weeks Signup and view all the answers

Which of the following is a common presenting symptom of ear obstruction due to an infection?

Erythema and edema of the EAC Signup and view all the answers

Which condition can cause necrotizing (malignant) otitis externa?

An infection in diabetics Signup and view all the answers

What is the hallmark sign of otitis externa during a physical examination?

Pain upon palpation of the tragus Signup and view all the answers

What is a significant contributing factor to the development of otitis externa?

Trapping of moisture in the external auditory canal Signup and view all the answers

What type of discharge is typically observed in the early stages of otitis externa?

Clear and watery Signup and view all the answers

Which symptom is less commonly observed in cases of ear obstruction due to infection?

Bilateral symptoms Signup and view all the answers

What type of infection can otomycosis cause in the ear canal?

Fungal infection Signup and view all the answers

Which statement best describes acute localized otitis externa?

It typically arises from an infection of a hair follicle. Signup and view all the answers

What can contribute to the alteration of pH in the ear canal?

Excessive ear cleaning Signup and view all the answers

How might an immunocompromised patient present with otitis externa?

With necrotizing otitis externa Signup and view all the answers

Who is most likely to experience necrotizing otitis externa?

A diabetic adult Signup and view all the answers

Which activity is likely to increase the risk of developing otitis externa?

Swimming or surfing Signup and view all the answers

Study Notes

Otitis Externa

An inflammation or infection of the external auditory canal (EAC), the auricle, or both.
Can be found in all age groups.

Otitis Externa Classification

Acute Diffuse OE: Most common form, typically seen in swimmers
Acute Localized OE: Associated with infection of a hair follicle.
Chronic OE: Same as acute diffuse OE but of longer duration (>6 weeks).
Otomycosis: Infection of the ear canal from a fungal species.
Eczematous OE: Encompasses various dermatologic conditions such as atopic dermatitis, psoriasis, systemic lupus erythematosus, and eczema.
Necrotizing (malignant) OE: Infection that extends into the deeper tissues adjacent to the EAC; occurs primarily in immunocompromised adults (e.g., diabetics, patients with AIDS).

Pathophysiology

Moisture retention: Trapped moisture in the EAC can macerate the skin and create a breeding ground for bacteria.
Obstruction: Excessive cerumen, debris, surfer's exostosis, or a narrow and tortuous canal can lead to infection by means of moisture retention.
Absence of cerumen: Repeated water exposure or overcleaning can lead to infection.
Trauma: Can alter the ear canal pH and lead to infection.
Inflammatory Response: Inflammation, edema, exudate, and pus can occur in the EAC. Infection can spread to cause cellulitis of the face or neck.

Presenting Symptoms

Otalgia: Pain, ranging from mild to severe, typically progressing over 1-2 days.
Discharge: Initially clear, quickly becomes purulent and foul-smelling.
Hearing loss
Ear fullness or pressure
Erythema, edema, and narrowing of the EAC
Tinnitus
Fever
Itching: Especially in fungal OE or chronic OE
Severe Deep Pain: Immunocompromised patients may have necrotizing OE.
Cellulitis of the face or neck or lymphadenopathy of the ipsilateral neck
Bilateral symptoms: Rare
History of exposure to or activities in water: Frequent (e.g., swimming, surfing, kayaking)
History of preceding ear trauma: Usually (e.g., forceful ear cleaning, use of cotton swabs, or water in the ear canal)

Physical Exam

Pain upon palpation of the tragus or application of traction to the pinna: Hallmark of OE.
Erythema, edema, and narrowing of the external auditory canal
Purulent or serous discharge
Conductive hearing loss
Cellulitis of the face or neck or lymphadenopathy of the ipsilateral neck: Can occur in some patients.

Differential Diagnosis

Ear canal trauma
Ear canal carcinoma
Otitis media with a perforation
Preauricular cyst and fistula
Chondritis
Lacerations
Cranial nerve palsy
Atopic dermatitis
Cerumen impaction
Foreign body
Herpes Zoster Oticus
Intracranial abscess
Skull base osteomyelitis
Furuncle
Hearing loss
Wisdom tooth eruption

Treatment

Pain management
Debris removal from the canal
Topical medications: Control edema and infection. Ciprofloxacin-Hydrocortisone and Neomycin-polymyxin B-hydrocortisone are first-line agents.
Avoidance of contributing factors:
Prescribe an initial seven-day course of topical medication: Continue for an additional week if symptoms have not resolved.
Reevaluation for treatment failure: If symptoms persist after one to two weeks.

Geriatric Population

Necrotizing External Otitis: Typically occurs in older adults with diabetes mellitus or immunocompromise.
Infection and damage to the bones of the ear canal and at the base of the skull: Hallmark sign is granulation tissue in the deep meatus at the bony cartilaginous junction.

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Description

Explore the various forms and classifications of otitis externa, a common ear condition affecting individuals across all ages. This quiz delves into the specifics of acute and chronic types, along with their pathophysiology. Test your understanding of this important medical topic.