Otitis Externa Review

Abstract

TARGET AUDIENCEPhysicians, nurse practitioners, and physician assistants who evaluate and care for children with minor illnesses.Specialists including pediatricians, emergency physicians, pediatric emergency physicians, family practitioners, otolaryngologists, pediatric nurse practitioners, and nurses working in school or camp setting will find this information particularly useful. LEARNING OBJECTIVESAfter completion of this article, the reader will be able to: 1. Define the pathogenesis and microbiology of otitis externa. 2. Describe the presenting sign and symptoms in children with infections of the external ear, as well as the complications. 3. Discuss the therapeutic options, including topical antibiotic drugs, anti-inflammatory agents, and the use of mechanical interventions (wick, ear plugs). DEFINITIONO titis externa (OE), also known as ''swimmer's ear''or ''tropical ear,'' is a disease process that includes infection or inflammation of the external ear canal. It can range from mild inflammation to a very severe disease process known as necrotizing otitis externa. It is caused by a break in the normal skin/cerumen protective barrier in the external ear canal usually under the conditions of elevated humidity and warmer temperature.Three clinical stages of OE have been described: preinflammatory, acute inflammatory, and chronic. The preinflammatory stage results from moisture or local trauma in the ear canal. The skin becomes edematous, obstructing the glands. This process predisposes the ear to further trauma. The acute inflammatory stage of OE can be classified into mild, moderate, and severe stages. In the mild acute inflammatory stage, the canal is erythematous and edematous, and develops clear odorless secretions. Moderate acute inflammatory OE has increased edema and pain, and the secretions become seropurulent. Severe inflammatory OE is intensely painful and involves a lumen that is obstructed with draining secretions and debris. It is often accompanied with periauricular edema and adenopathy. If the infection spreads to surrounding tissues, the condition is known as necrotizing OE. Finally, chronic OE is defined as a single episode lasting longer than 4 weeks or 4 or more episodes in 1 year. 1

Retrospective Analysis of Patients Diagnosed with Otitis Clinically in Our Clinic

“…Otitis eksterna, esas olarak auriküla ve dış kulak yolunun enfeksiyon ve inflamasyonunu içerir. Otitis media (OM) ise orta kulak boşluğu ve mastoid kemik ile östaki ağzındaki mukozanın enfeksiyon ve inflamasyonudur (1,2) . OM, seröz otitis media (SOM), akut otitis media (AOM), kronik otitis media ve buna bağlı komplikasyonlar olmak üzere alt gruplara ayrılabilir (3) .…”

Freshwater Fungal Infections

“…38,40 Exposure to water, especially polluted water, and swimming are well-recognized risk factors for AOE. 37,41 In one study, the most frequent predisposing factors for candidal otitis externa were swimming in public pools/baths and diabetes mellitus. 42 Diagnosis is made by culture 41 or perhaps by polymerase chain reaction assay.…”

“…This entity is generally characterized by symptoms of ear pain, typically worsened by manipulation of the tragus or pinna; itching, often as a preceding symptom; and sometimes hearing loss or sense of fullness or blockage in the ear. 37 Signs include ear canal erythema and edema, with varying amounts of debris or otorrhea. 37 Studies suggest that the aforementioned symptoms, hearing loss and lack of fetid discharge may particularly characterize fungal otitis externa.…”

“…37 Signs include ear canal erythema and edema, with varying amounts of debris or otorrhea. 37 Studies suggest that the aforementioned symptoms, hearing loss and lack of fetid discharge may particularly characterize fungal otitis externa. 38,39 A comprehensive microbiological study in the United States indicated that fungi cause 1%-2% of AOE, with no significant geographical differences in proportion.…”

“…5,10 Specific individual preventive measures include use of earplugs while swimming (and, in those with recurrent infection, gently rinsing the ear canals after swimming with equal portions of vinegar and rubbing alcohol) to prevent AOE, 37 and washing feet thoroughly after public swimming or bathing. 53 Additionally, one should ensure proper use of contact lenses (including therapeutic lenses) and contact lens solution (avoiding tap water), 26 wash all wounds thoroughly and take care not to aspirate potentially contaminated freshwater.…”