Edit concept Question Editor Create issue ticket

Chronic Otitis Externa


Presentation

  • New and old therapies and promising approaches to the treatment of this often recalcitrant problem are presented in this review.[ncbi.nlm.nih.gov]
  • Patients typically present with one of two types of clinical exams. The first is with dry scaly ear canals (see picture on the right).[waent.org]
Chronic Infection
  • In dogs with very chronic infections and/or severe allergic skin disease (skin does in fact line the er canal). Over time the glands hypertrophy, or enlarge and overproduce, to such a degree that the canals basically swell shut.[aperc.com]
  • Chronic infections, however, can last several weeks or months.[humanillnesses.com]
  • Predisposing factors for otitis externa 5 Type Factor Anatomical Narrow external auditory meatus: hereditary or acquired, for example chronic infection, exostoses, iatrogenic.[gponline.com]
  • There are many local predisposing factors of otomycosis such as chronic infection of the ear, use of oils, ear-drops, steroids, swimming and evidence of fungal infection elsewhere such as vaginitis or onychomycosis, etc.[aspergillus.org.uk]
  • Complicated otitis externa The main complications of acute external otitis are spread of the infection to other soft tissues, persistent chronic infection, and the development of skull bone infection (termed malignant or necrotizing otitis externa, or[en.citizendium.org]
Amyloidosis
  • Underlying autoimmune problems such as Sjögren's disease, sarcoidosis, and amyloidosis must be searched and, if present, addressed and treated for resolution of symptoms.[ncbi.nlm.nih.gov]
Veterinarian
  • Otitis externa can be extremely frustrating for owners and veterinarians alike, especially in the case of chronic otitis externa.[vetmed.illinois.edu]
Fishing
  • Juha_Kristian Angel Fish # of Dives: 500 - 999 Location: Finland, Helsinki Hi there, I would like to understand the treatment of chronic otitis externa.[scubaboard.com]
Aspiration
  • […] tissue and bony sequestra may be required Hyperbaric oxygen therapy is often reserved for refractory or recurrent cases or for patients with extensive skull base and intracranial involvement Abscess or cellulitis Incision and drainage will be required (aspiration[entsho.com]
  • While loss of movement on one side of the face (cranial nerve VII) is not a fatal condition, loss of swallowing and laryngeal reflexes (Cranial nerves V (trigeminal), VII (facial), X (vagus), XI (accessory), and XII (hypoglossal)) may lead to aspiration[en.citizendium.org]
Flushing
  • Alcohol flush and warm-air ventilation dry the canal, and a hydrophobic cream lubricates and seals the stratum corneum from moisture, fungus, and bacteria.[ncbi.nlm.nih.gov]
  • The middle ear is often harboring the bacteria that keep the infection going, so the middle ear is cleaned thoroughly and flushed as the ear canal is removed. This may seem aggressive, but at this point, aggressive is the idea.[aperc.com]
  • Such damage may necessitate surgery, and a perforated tympanic membrane associated with flushing is a common cause of litigation. 13 , 14 In addition, flushing may cause further trauma to the ear canal.[aafp.org]
  • There may be a some water entry, but it will not be the flushing immersion experienced in an unobstructed outer ear canal.[scubaboard.com]
  • If an ear drum contains even a small perforation, use of these products or flushing of the ear canal may cause additional problems (e.g., tinnitus, vertigo, hearing loss). Some of these complications may require surgery.[nmihi.com]
Keratosis
  • Other infective otitis externa, right ear H60.392 Other infective otitis externa, left ear H60.393 Other infective otitis externa, bilateral H60.399 Other infective otitis externa, unspecified ear H60.4 Cholesteatoma of external ear Inclusion term(s): Keratosis[icd10coded.com]
  • […] canal H60.1 Cellulitis of external ear Cellulitis of: · auricle · external auditory canal H60.2 Malignant otitis externa H60.3 Other infective otitis externa Otitis externa: · diffuse · haemorrhagic Swimmer's ear H60.4 Cholesteatoma of external ear Keratosis[apps.who.int]
  • Obstruction of normal meatus: keratosis obturans, foreign body, hearing aid, hirsute ear canal. Dermatological Eczema, seborrhoeic dermatitis. Allergic Atopy, non-atopic allergy, sensitivity to topical preparations.[gponline.com]
Hyperpigmentation
  • Both contact dermatitis and aural eczematoid dermatitis cause itching, redness, clear (serous) discharge, desquamation, hyperpigmentation, and, sometimes, fissuring.[msdmanuals.com]
Excoriation
  • Mucopurulent otorrhea and excoriated skin may also be present. The causative bacteria vary greatly because many of the patients have already received prolonged topical therapy. At times, only normal flora can be cultured.[aafp.org]
Otalgia
  • The most common symptoms related to AOE described by patients are otalgia and otorrhea. Complaints of otalgia can range from mild pruritus to severe discomfort. Patients have also described a feeling of fullness or pressure in the ear.[contemporaryclinic.pharmacytimes.com]
  • Symptoms of inflammation in OE usually are rapid in onset (generally within 48 hours) and include otalgia, pruritus, a sense of …[pedsinreview.aappublications.org]
  • Symptoms of ear canal inflammation, including otalgia (often severe), itching or fullness WITH OR WITHOUT hearing loss or jaw pain* AND 3.[cps.ca]
  • Other than these, the following are the sign and symptoms: The pain range of Otalgia extends from mild to severe gradually increasing within 1 to 2 days.[medicalfoxx.com]
Ear Discharge
  • These patients may have clear ear discharge, sometimes this discharge could be seen admixed with white flakes. The skin lining the external canal may be erythematous and shiny in appearance.[sites.google.com]
  • NIH: National Institute on Deafness and Other Communication Disorders Cholesteatoma (Medical Encyclopedia) Ear discharge (Medical Encyclopedia) Ear examination (Medical Encyclopedia) Ear infection - acute (Medical Encyclopedia) Ear infection - chronic[icdlist.com]
  • Peter CC BY 3.0], via Wikimedia Commons Figure 2 – Otitis Externa affecting a patient’s left ear Differential Diagnosis Important differentials to consider for anyone presenting with ear discharge include: Otitis media with perforation – usually clear[teachmesurgery.com]
  • Your doctor may also take a sample of ear discharge or debris for laboratory analysis. This allows them to determine the organism causing the recurring infection.[healthline.com]
  • […] itching that persists or worsens after a few days of home treatment Any ear discomfort lasting longer than a few days Swelling, redness or extreme pain in the ear canal, the opening to the ear canal, the external ear, or the skin around the external ear[health24.com]
Ear Fullness
  • Clinical Features The classical clinical picture of otitis externa is progressive ear pain with a purulent discharge (Fig. 2), alongside itchiness or ear fullness. Less common symptoms include hearing loss, tinnitus, or describing a swollen ear.[teachmesurgery.com]
  • Patients may also have the following signs and symptoms: Otalgia - Ranges from mild to severe, typically progressing over 1-2 days Hearing loss Ear fullness or pressure Erythema, edema, and narrowing of the EAC Tinnitus Fever (occasionally) Itching (especially[emedicine.medscape.com]
Hearing Problem
  • If your child isn't old enough to say "My ear hurts," here are a few things to look for Tugging at ears Crying more than usual Fluid draining from the ear Trouble sleeping Balance difficulties Hearing problems Your health care provider will diagnose an[icdlist.com]
Erythematous Ear Canal
  • ear canal, tympanic membrane may be partially obscured Grade III The ear canal is oedematous, erythematous, and occluded (often completely closed), and the tympanic membrane cannot be seen Grade IV The tympanic membrane is obscured, perichondritis and[teachmesurgery.com]
Suggestibility
  • This significant age difference suggests that contact hypersensitivity is not an aetiological factor in the younger patient. There was no significant difference in the duration of otitis externa between those with positive and negative tests.[ncbi.nlm.nih.gov]
  • This would be suggestive of an accompanying fungus. In diabetics or immune-suppressed individuals, chronic external otitis can become a very serious disease (malignant external otitis).[medicinenet.com]
  • However, it is suggested to keep water out of the ear, especially when using shampoo for hair washing. Do not use cotton buds.[ensg.co.nz]
  • Bloomberg Children’s Center, Baltimore, MD Suggested Reading Clinical Practice Guideline: Acute Otitis Externa. Rosenfeld RM , Brown L , Cannon R , et al . Otolaryngol Head Neck Surg . 2006 ; 134 ( 4 suppl): S4 – S23 Diagnosis of Ear Pain.[pedsinreview.aappublications.org]
Fear
  • Treatment is aimed at eliminating the primary source for the infection (external ear canal), treating any underlying systemic disease effectively, managing the person’s pain, distress and fear, eliminating the bacteria from the bone and soft tissue which[en.citizendium.org]

Workup

  • […] better depicts bony erosion [5] Radionucleotide bone scanning Gallium scanning Magnetic resonance imaging (MRI) - Not used as often as the other modalities; may be considered secondarily or if soft-tissue extension is the predominant concern [6] See Workup[emedicine.medscape.com]

Treatment

  • Thus surgical intervention plays an important role in the treatment of otitis externa not responding to treatment.[ncbi.nlm.nih.gov]
  • Treatment of otitis externa. Nurse Prescribing , Vol. 6, Issue. 1, p. 6.[cambridge.org]

Prognosis

  • […] infections, surgery can be performed to improve patency (but see below) Sometimes, recurrent infection leads to formation of a false fundus and patients tend to find that they suffer little or no further AOE; they may choose to live with the hearing deficit PROGNOSIS[entsho.com]
  • Section 4: Prognosis While most patients will improve rapidly if the correct treatment is commenced, acute otitis externa may progress, despite treatment, requiring acute ENT referral.[gponline.com]
  • Inclusion of steroids in the drops improves prognosis. (Roland et al. 2003) Uncommon treatments: Steroids -- oral, nasal and injected steroids are occasionally used but their use is presently controversial.[dizziness-and-balance.com]
  • Prognosis Most incidents of OE resolve without difficulty. The majority of patients improve within 48-72 hours of antibiotic administration.[emedicine.medscape.com]
  • Prognosis [ edit ] Otitis externa responds well to treatment, but complications may occur if it is not treated.[en.wikipedia.org]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Introduction: Chronic otitis externa is a chronic inflammation involving the skin lining of the external auditory canal of unknown etiology. Diverse mechanisms from allergy to autoimmune reaction has been implicated.[sites.google.com]
  • Pathology It can present in several forms: acute otitis externa chronic otitis externa necrotizing otitis externa Etiology There are several known risk factors which include 1 : swimming a humid environment narrow ear canals hearing-aid use mechanical[radiopaedia.org]
  • […] skin/exocrine Synonym(s): swimmer’s ear Epidemiology Incidence Unknown; higher in the summer months and in warm, wet climates Predominant age: all ages Predominant sex: male female Prevalence Acute, chronic, and eczematous: common Necrotizing: uncommon Etiology[unboundmedicine.com]
  • BACTERIAL OTITIS EXTERNA Etiology and Presentation Like all skin, the external auditory canal has a normal bacterial flora and remains free of infection unless its defenses are disrupted.[aafp.org]

Epidemiology

  • Epidemiology It is quite a common condition and may affect up to 10% of people during their lifetime.[radiopaedia.org]
  • […] primary skin conditions Necrotizing malignant otitis externa: an infection that extends into the deeper tissues adjacent to the canal; may include osteomyelitis and cellulitis; rare in children System(s) affected: skin/exocrine Synonym(s): swimmer’s ear Epidemiology[unboundmedicine.com]
  • […] countries. [9] Age-, sex-, and race-related demographics Although the infection can affect all age groups, OE appears to be most prevalent in the older pediatric and young adult population, with a peak incidence in children aged 7-12 years. [12] A single epidemiologic[emedicine.medscape.com]
  • Section 1: Epidemiology and aetiology Acute otitis externa is inflammation of the external ear canal manifested by a range of causative factors.[gponline.com]
  • Epidemiology Otitis externa is common and manifests as an acute or chronic form. The acute form affects four in 1,000 persons annually and the chronic form affects 3-5% of the population.[aspergillus.org.uk]
Sex distribution
Age distribution

Pathophysiology

  • Synonym(s): swimmer’s ear Epidemiology Incidence Unknown; higher in the summer months and in warm, wet climates Predominant age: all ages Predominant sex: male female Prevalence Acute, chronic, and eczematous: common Necrotizing: uncommon Etiology and Pathophysiology[unboundmedicine.com]
  • Pathophysiology Otitis externa typically affects the external auditory canal – the part of the ear via which sound waves travel to reach the tympanic membrane.[teachmesurgery.com]
  • Pathophysiology Otitis is inflammation and/or an infectious process of the ear. Three types of otitis can occur, and their names are indicative of the area of the ear they affect.[contemporaryclinic.pharmacytimes.com]
  • Pathophysiology OE is a superficial infection of the skin in the EAC.[emedicine.medscape.com]
  • Pathophysiology of atopic dermatitis. Clin Dermatol 2003;21:116–121. Wang MC, Liu CY, Shiao AS, Wang T (August 2005). "Ear problems in swimmers". J Chin Med Assoc. 68 (8): 347–52. doi : 10.1016/S1726-4901(09)70174-1. PMID 16138712.[en.wikipedia.org]

Prevention

  • In most cases of COE, creating a well-aerated, dry, self-cleaning external auditory canal prevents further infection. This can usually be accomplished by medical treatment that includes suction and swabbing.[ncbi.nlm.nih.gov]
  • The lumen of the ear canals will also become extremely stenotic, which prevents medications from passing into the horizontal ear canal and reaching the tympanic membrane.[vetmed.illinois.edu]
  • Prevention To prevent ear infections, avoid swimming in polluted water and keep the ears as dry as possible.[medicalnewstoday.com]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!