OTITIS EXTERNA

WHAT IS OTITIS EXTERNA & IT’S TYPE
TREATMENT OF DIFFERENT TYPES OF OE
DIAGNOSTIC EVALUATION AND HISTORY TAKING
COMPLICATIONS AND DIFFERENTIAL DIAGNOSIS
MANAGEMENT & PREVENTION
PRESCRIPTION OF PROBABLE DIAGNOSIS


Otitis externa is a condition that causes inflammation (redness and swelling) of the external ear canal, which is the tube between the outer ear and eardrum.

1. Otitis Externa DR AWAIS IRSHAD 1

2. LEARNING OBJECTIVES WHAT IS OTITIS EXTERNA & IT’S TYPE TREATMENT OF DIFFERENT TYPES OF OE DIAGNOSTIC EVALUATION AND HISTORY TAKING COMPLICATIONS AND DIFFERENTIAL DIAGNOSIS MANAGEMENT & PREVENTION PRESCRIPTION OF PROBABLE DIAGNOSIS Presentation title 2

3. A 30 years old male patient presented in ENT clinic with a complain of right earache for last 2 days . The pain is aggravated on chewing of food and during speech . On examination of right ear, pressure on the tragus is painful and there is small red swelling arising from the anterior wall of external auditory canal which is partially occluding the canal with no discharge in right ear. Left ear examination is normal. Rennie’s test is negative in right ear and positive in left ear, Weber test lateralizes towards right ear. Presentation title 3

4. OTITIS EXTERNA Otitis externa is a condition that causes inflammation (redness and swelling) of the external ear canal, which is the tube between the outer ear and eardrum. 4

5. DIVISION OF OTITIS EXTERNA Otitis externa may be divided into two main group 1. INFECTIVE GROUP 5

6. 2. Reactive Group Eczematous otitis externa Seborrheic otitis externa Neurodermatitis Presentation title 6

7. (a) Furuncle (localized acute otitis externa) A furuncle is a staphylococcal infection of the hair follicle. As the hair are confined only to the cartilaginous part of the meatus, furuncle is seen only in this part of meatus Presentation title 7

8. severe pain  tenderness  Movements of the pinna are painful Jaw movements, as in chewing, also cause pain in the ear.  A furuncle of posterior meatal wall causes oedema over the mastoid with obliteration of the  groove RETROAURICULAR.  Preauricular lymph nodes may also be enlarged and TENDER 8 PRESENTING COMPLAIN

9. Presentation title 9 TREATMENT In early cases, systemic antibiotics, analgesics and local heat 10% ichthammol glycerine provides splintage and reduces pain Hygroscopic action of glycerine reduces oedema ichthammol is mildly antiseptic. If abscess has formed, incision and drainage should be done. In case of recurrent furunculosis , diabetes should be excluded, and attention paid to the patient’s nasal vestibules which may harbour staphylococci and the infection transferred by patient’s fingers.

10. It is diffuse inflammation of meatal skin which may spread to involve the pinna and epidermal layer of tympanic membrane . Disease is commonly seen in hot and humid climate and in swimmers ACUTE PHASE hot burning sensation thin serous discharge cellulitis CHRONIC PHASE IRRITATION  ITCHING Discharge is scanty and may dry up to form crusts, meatal stenosis 10 b) Diffuse otitis externa

11. (c) OTOMYCOSIS   Otomycosis . Otomycosis is a fungal infection of the ear canal that often occurs due to Aspergillus niger, or Candida albicans. PRESENTING COMPLAIN: watery discharge with a musty odour ITICHING  EAR BLOCKAGE fungal mass may appear white, brown or black TREATMENT ear toilet to remove all discharge and epithelial debris which are conducive to the growth of fungus. It can be done by syringing, suction or mopping 11 Nystatin (100,000 units/mL of propylene glycol) is effective against Candida

12. Presentation title 12 (d) OTITIS EXTERNA HAEMORRHAGICA   It is characterized by formation of haemorrhagic bullae on the tympanic membrane and deep meatus. blood-stained discharge when the bullae rupture   Treatment with analgesics is directed to give relief from pain. Antibiotics are given for secondary infection of the ear canal, or middle ear if the bulla has ruptured into the middle ear.

13. (e) Herpes zoster oticus   It is characterized by formation of vesicles on the tympanic membrane, meatal skin, concha and postauricular groove. The VII and VIII cranial nerves may be involved.   (F) Malignant (necrotizing) otitis externa.  It is an inflammatory condition caused by pseudomonas infection usually in the elderly diabetics, or in those on immunosuppressive drugs. Presentation title 13

14. 2. REACTIVE GROUP (A) ECZEMATOUS OTITIS EXTERNA Cause: It is result of hypersensitivity to infective organisms or topical ear drops such as chloromycetin or neomycin, etc. Clinical features: It is marked by intense irritation, vesicle formation, oozing and crusting in the canal. Treatment: is withdrawal of topical antibiotic causing sensitivity and application of steroid cream (b) SEBORRHOEIC OTITIS EXTERNA It is associated with seborrhoeic dermatitis of the scalp. Clinical features: Itching is the main complaint. Greasy yellow scales are seen in the external canal, over the lobule and postauricular sulcus. Treatment: consists of ear toilet, application of a cream containing salicylic acid and sulfur, and attention to the scalp for seborrhoea . Presentation title 14

15. (c) NEURODERMATITIS. Cause: It is caused by compulsive scratching due to psychological factors. Clinical features: Patient's main complaint is intense itching. Otitis externa of bacterial type may follow infection of raw area left by scratching. Treatment: is sympathetic psychotherapy and that meant for any secondary infection. Ear pack and bandage to the ear are helpful to prevent compulsive scratching . Presentation title 15

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18. A 30 years old male patient presented in ENT clinic with a complain of right earache for last 2 days . The pain is aggravated on chewing of food and during speech . On examination of right ear, pressure on the tragus is painful and there is small red swelling arising from the anterior wall of external auditory canal which is partially occluding the canal with no discharge in right ear. Left ear examination is normal. Rennie’s test is negative in right ear and positive in left ear, Weber test lateralizes towards right ear. 1 . What specific question you would ask in history to aid and elicit the diagnosis? 2. Give your differential diagnosis. 3. Give management plan of most probable diagnosis. 4. What type of hearing loss is present on the basis of tuning fork test? 5. What complication can occur in this patient? 6. Write the prescription for the probable  diagnosis? Presentation title 18

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22. Presentation title 22 COMPLICATION AND PREVENTION

23. PRESCRIPTION OF PROBABLE DIAGNOSIS Presentation title 23

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