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Revision as of 19:34, 21 September 2017

Otitis externa Microchapters

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Differentiating Otitis Externa from other Diseases

Epidemiology and Demographics

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Physical Examination

Laboratory Findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Template:Chi; Maliha Shakil, M.D. [2]; Suveenkrishna Pothuru, M.B,B.S. [3]; Luke Rusowicz-Orazem, B.S.; Tarek Nafee, M.D. [4]

Overview

The mainstay of therapy for acute otitis externa (AOE) includes cleaning of the external auditory meatus and treating the infection. Topical therapy is recommended as the initial therapy for diffuse uncomplicated acute otitis externa. Systemic antimicrobials should be reserved for infections extending outside the external ear canal or patients with specific risk factors. Analgesics such as acetaminophen or nonsteroidal anti-inflammatory drugs are administered either alone or in combination with an opioid.

Medical Therapy

Topical therapy is recommended as initial therapy for diffuse uncomplicated AOE. A non-ototoxic topical preparation should be used when the patient has a known or suspected perforation of the tympanic membrane. Systemic antimicrobials may be administered if there is extension outside the external ear canal or in the presence of the following risk factors that would indicate a need for systemic therapy:[1]

Otitis externa

  • 1. Otitis externa, acute [2]
  • 1.1 Causative pathogens
  • Pseudomonas aeruginosa
  • Candida spp.
  • Enterobacteriaceae
  • Proteus spp.
  • Staphylococcus aureus
  • 1.2 Empiric antimicrobial therapy
  • 1.3 Pathogen-directed therapy
  • 1.3.1 Fungal otitis externa[2]
  • 1.3.2 Malignant otitis media, Pseudomonas aeruginosa[2]
  • 2. Otitis externa, chronic[2]
  • 2.1 Empiric antimicrobial therapy

Pain Management

Analgesia should be administered based on the severity of pain. Mild to moderate pain is usually managed with acetaminophen or nonsteroidal anti-inflammatory drugs given alone or in combination with an opioid. Fentanyl, morphine, and hydromorphone are indicated for procedure-related and moderate to severe pain.

Algorithm for the Approach to Acute Otitis Externa

Abbreviations: AOE, acute otitis externa; TM, tympanic membrane. (Adapted from Clinical Practice Guideline: Acute Otitis Externa)[3]

 
 
 
 
Diffuse AOE
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Analgesic based on severity
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Extension beyond ear canal or ⊕ factors requiring systemic Rx?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
 
 
 
 
NO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Abx against P. aeruginosa and S. aureus
 
 
 
 
 
Perforated TM?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
 
 
 
 
NO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-otoxic topical agent
 
 
 
 
 
Topical agent
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Obstructed ear canal?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
 
 
 
 
NO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Aural toilet or wick placement
 
 
 
 
 
Educate pt on how to use ear drops
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Clinically improve in 3 days?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
 
 
 
 
NO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Complete Rx course
 
 
 
 
 
Illness other than AOE?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
YES
 
 
 
 
 
NO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treat accordingly
 
 
 
 
 
Assess Rx adherence/delivery
 
 
 
 
 
 
 
 

References

  1. Rosenfeld, Richard M.; Schwartz, Seth R.; Cannon, C. Ron; Roland, Peter S.; Simon, Geoffrey R.; Kumar, Kaparaboyna Ashok; Huang, William W.; Haskell, Helen W.; Robertson, Peter J. (2014-02). "Clinical practice guideline: acute otitis externa". Otolaryngology--Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 150 (1 Suppl): –1-S24. doi:10.1177/0194599813517083. ISSN 1097-6817. PMID 24491310. Check date values in: |date= (help)
  2. 2.0 2.1 2.2 2.3 Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA; et al. (2014). "Clinical practice guideline: acute otitis externa executive summary". Otolaryngol Head Neck Surg. 150 (2): 161–8. doi:10.1177/0194599813517659. PMID 24492208.
  3. Rosenfeld, Richard M.; Schwartz, Seth R.; Cannon, C. Ron; Roland, Peter S.; Simon, Geoffrey R.; Kumar, Kaparaboyna Ashok; Huang, William W.; Haskell, Helen W.; Robertson, Peter J. (2014-02). "Clinical practice guideline: acute otitis externa". Otolaryngology--Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 150 (1 Suppl): –1-S24. doi:10.1177/0194599813517083. ISSN 1097-6817. PMID 24491310. Check date values in: |date= (help)

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