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==Overview==
Otitis externa is classified as acute, chronic, or malignant based on the duration of the disease, as well as diffusion and severity of infection and symptoms.


==Classification==
==Classification==
Based on the duration of symptoms, otitis externa may be classified into either acute or chronic.
Otitis externa is classified by duration, diffusion, and symptom severity.


===Acute Otitis Externa===
===Acute Otitis Externa===
Acute otitis externa is predominantly a microbial infection, occurs rather suddenly, rapidly worsens, and becomes very painful and alarming. The ear canal has an abundant nerve supply, so the [[pain]] is often severe enough to interfere with sleep. Wax in the ear can combine with the [[swelling]] of the canal skin and any associated pus to block the canal and dampen hearing to varying degrees, creating a temporary [[conductive hearing loss]]. In more severe or untreated cases, the infection can spread to the [[soft tissue]]s of the face that surround the adjacent [[parotid gland]] and the jaw joint, making chewing painful. In its mildest forms, external otitis is so common that some ear, nose and throat physicians have suggested that most people will have at least a brief episode at some point in life. While a small percentage of people seem to have an innate tendency toward chronic external otitis, most people can avoid external otitis altogether once they understand the mechanisms of the disease.
*Otitis externa is characterized as "acute" if the following conditions are satisfied:<ref name="pmid24421666">{{cite journal |vauthors=Hui CP |title=Acute otitis externa |journal=Paediatr Child Health |volume=18 |issue=2 |pages=96–101 |year=2013 |pmid=24421666 |pmc=3567906 |doi= |url=}}</ref>
**Onset within 48 hours.
**Primarily caused by [[bacterial]] infection of ''[[Pseudomonas aeruginosa]]'' and ''[[Staphylococcus aureus|Staphylococcus aureus]]''.<ref name="pmid23198673">{{cite journal |vauthors=Schaefer P, Baugh RF |title=Acute otitis externa: an update |journal=Am Fam Physician |volume=86 |issue=11 |pages=1055–61 |year=2012 |pmid=23198673 |doi= |url=}}</ref>
**[[Otalgia]] and feelings of [[itchiness]] or "fullness" of the [[ear canal]].
**[[Erythema]] or [[edema]] of [[ear canal]].<ref name="pmid24421666">{{cite journal |vauthors=Hui CP |title=Acute otitis externa |journal=Paediatr Child Health |volume=18 |issue=2 |pages=96–101 |year=2013 |pmid=24421666 |pmc=3567906 |doi= |url=}}</ref>
**Tenderness of the [[tragus]] and [[pinna]].
*Hearing loss is not usually associated with acute presentations of otitis externa.<ref name="pmid24421666">{{cite journal |vauthors=Hui CP |title=Acute otitis externa |journal=Paediatr Child Health |volume=18 |issue=2 |pages=96–101 |year=2013 |pmid=24421666 |pmc=3567906 |doi= |url=}}</ref>
*Acute otitis externa is treated with [[topical]] or [[systemic]] [[antibiotics]] for 7-10 days.
*Clinical response will usually be seen within 48-72 hours; full symptom resolution is usually achieved within 14 days.  
*Acute otitis externa is localized to the [[ear canal]] and is not characterized by diffusion of infection throughout the ear and head.


===Chronic Otitis Externa===
===Chronic Otitis Externa===
Chronic otitis externa is a low-grade disease, usually non-microbial and purely on the basis of chronic [[dermatitis]] or irritation from cleaning the canal, often with cotton swabs. It can be thought of as chronic [[dermatitis]] of the ear canal skin and may or may not be painful. There may only be seepage, mild [[swelling]], or [[itching]].
*Otitis externa is considered chronic for cases that persist greater than 3 months with treatment.<ref name="pmid24421666">{{cite journal |vauthors=Hui CP |title=Acute otitis externa |journal=Paediatr Child Health |volume=18 |issue=2 |pages=96–101 |year=2013 |pmid=24421666 |pmc=3567906 |doi= |url=}}</ref>
**Usually, it is diagnosed for cases in which [[antibiotic]] therapy does not alleviate symptoms.
*Chronic otitis externa is primarily caused by the following:
**[[Otomycosis]], particularly by ''[[Candida albicans]]'' and ''[[Aspergillus niger]]''
**Allergic [[rhinitis]]
**Underlying [[dermatoses]]:
***[[Eczema]]
***[[Seborrhea]]
***[[Psoriasis]]
***[[Contact dermatitis]]
*Symptoms of chronic otitis externa are predominantly [[itching]], due to the presence of dermatalogical condition or [[fungal]] debris.
**[[Otorrhea]] is more common in chronic otitis externa than the acute presentation.
*Treatment of chronic otitis externa resolves around treating the underlying condition, including [[corticosteroid]] therapy for dermatological conditions and topical anti-[[fungal]] medications for [[otomycosis]].<ref>{{cite journal |author=Yaganeh Moghadam A, Asadi MA, Dehghani R, Zarei Mahmoudabadi A, Rayegan F, Hooshyar H, Khorshidi A |title=Evaluating the effect of a mixture of alcohol and acetic acid for otomycosis therapy |journal=Jundishapur J Microbiol |volume=3 |issue=2 |pages=66–70 |year=2010 |url=http://jjm.ajums.ac.ir/_jjm/documents/Issue%207MA.pdf |format=PDF}}</ref>
 
===Malignant Necrotizing Otitis Externa===
*Acute otitis externa becomes reclassified as malignant and necrotizing when the infectious pathogen diffuses from the [[ear canal]] and infects the [[temporal bones]], as well as bones in the ear adjacent to the canal, leading to damage and degradation.<ref name="pmid12892351">{{cite journal |vauthors=Handzel O, Halperin D |title=Necrotizing (malignant) external otitis |journal=Am Fam Physician |volume=68 |issue=2 |pages=309–12 |year=2003 |pmid=12892351 |doi= |url=}}</ref><ref name="urlMalignant otitis externa: MedlinePlus Medical Encyclopedia">{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/000672.htm |title=Malignant otitis externa: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
*It is usually caused by the [[bacterial]] pathogen responsible for the acute variant, usually ''[[Pseudomonas aeruginosa]]''.
*Otitis externa becomes malignant when the patient is [[immunocompromise|immunocompromised]].
**It usually occurs in acute otitis externa patients with [[diabetes]] or undergoing [[chemotherapy]], leading to reduced ability to counter the spread of the pathogen.
*Malignant otitis externa will usually manifest with the following symptoms:
**Severe [[otalgia]] and [[otorrhea]] that is not responsive to treatment.
**Granulated tissue in the [[ear canal]]
**Intracranial and neck complications:
***[[Fever]]
***Nerve damage in the head and neck.
***[[Osteitis]]
***[[Lymphadenitis]]
***Difficulty speaking or swallowing.
***[[Facial palsy]]
*Treatment of malignant otitis externa requires therapy targeting the pathogen as well as the source for [[immunocompromise|immunocompromisation]].


==References==
==References==

Revision as of 16:33, 5 May 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

Otitis externa is classified as acute, chronic, or malignant based on the duration of the disease, as well as diffusion and severity of infection and symptoms.

Classification

Otitis externa is classified by duration, diffusion, and symptom severity.

Acute Otitis Externa

Chronic Otitis Externa

Malignant Necrotizing Otitis Externa

  • Acute otitis externa becomes reclassified as malignant and necrotizing when the infectious pathogen diffuses from the ear canal and infects the temporal bones, as well as bones in the ear adjacent to the canal, leading to damage and degradation.[4][5]
  • It is usually caused by the bacterial pathogen responsible for the acute variant, usually Pseudomonas aeruginosa.
  • Otitis externa becomes malignant when the patient is immunocompromised.
    • It usually occurs in acute otitis externa patients with diabetes or undergoing chemotherapy, leading to reduced ability to counter the spread of the pathogen.
  • Malignant otitis externa will usually manifest with the following symptoms:
  • Treatment of malignant otitis externa requires therapy targeting the pathogen as well as the source for immunocompromisation.

References

  1. ↑ 1.0 1.1 1.2 1.3 Hui CP (2013). "Acute otitis externa". Paediatr Child Health. 18 (2): 96–101. PMC 3567906. PMID 24421666.
  2. ↑ Schaefer P, Baugh RF (2012). "Acute otitis externa: an update". Am Fam Physician. 86 (11): 1055–61. PMID 23198673.
  3. ↑ Yaganeh Moghadam A, Asadi MA, Dehghani R, Zarei Mahmoudabadi A, Rayegan F, Hooshyar H, Khorshidi A (2010). "Evaluating the effect of a mixture of alcohol and acetic acid for otomycosis therapy" (PDF). Jundishapur J Microbiol. 3 (2): 66–70.
  4. ↑ Handzel O, Halperin D (2003). "Necrotizing (malignant) external otitis". Am Fam Physician. 68 (2): 309–12. PMID 12892351.
  5. ↑ "Malignant otitis externa: MedlinePlus Medical Encyclopedia".

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