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Bacterial Otitis Externa

See Also
1. Otitis Externa
Epidemiology
1. Bacterial infection causes majority of Otitis Externa
Etiology
1. Most common
  1. Pseudomonas aeruginosa (50% of cases)
    1. More common in Diabetes Mellitus
    2. See Malignant External Otitis
  2. Staphylococcus aureus
  3. Proteus
  4. Escherichia coli
2. Atypical Bacteria
  1. Mycobacteria
    1. Chronic granulomatous and ulcerative canal lesions
  2. Mycoplasma
    1. Bullous lesions on tympanic membrane
Signs and Symptoms
1. See Otitis Externa
2. More severe than other forms of Otitis Externa
3. Significant canal swelling
4. Fever (rarely over 38.3 C or 101.0 F)
5. Lymphadenopathy anterior to tragus
Management
1. See Otitis Externa for General measures (Ear toilet)
  1. Ear cleaning and debridement is paramount
  2. Consider ear wick (see Otitis Externa)
2. Use caution if possible Tympanic Membrane Rupture
  1. Avoid ototoxic preparations
  2. Do not irrigate (suction only)
3. Otitis Externa Topical Medications
  1. Treatment course
    1. Use for 3 days after symptoms resolve
    2. Typical treatment course 5 to 7 days
  2. Ear canal acidification (as effective as Cortisporin)
    1. Acetic acid otic solution 2% (VoSol)
      1. Acetic acid with Hydrocortisone (Vosol HC)
      2. Acetic acid with Aluminum acetate (Otic Domeboro)
    2. Homemade
      1. 2% Otic Acetic Acid (white vinegar) drops tid OR
      2. 1:1 mix of 5% acetic acid and rubbing Alcohol tid
  3. Antibiotic preparations
    1. Risk of Neomycin-induced Contact Dermatitis: 5-18%
    2. Neomycin with Polymixin B and Hydrocortisone
      1. Cortisporin Otic Suspension 4 drops in ear tid
    3. Neomycin with Thonzonium and Hydrocortisone
      1. Coly-Mycin S
    4. Polymyxin B and Hydrocortisone (Otobiotic)
4. Resistant Cases (or allergy to neomycin)
  1. Treatment Course: 10 - 14 days
  2. Quinolone Preparations (instill twice daily)
    1. Ofloxacin 0.3% otic solution (Floxin Otic)
    2. Ofloxacin 0.3% ophthalmic solution (Ocuflox)
    3. Ciprofloxacin 0.3% with Hydrocortisone suspension
    4. Ciprofloxacin 0.3% ophthalmic solution (Ciloxan)
  3. Aminoglycoside Preparations (ophthalmic solutions)
    1. Gentamicin sulfate 0.3% (Garamycin)
    2. Tobramycin sulfate 0.3% (Tobrex)
5. Systemic antibiotic Indications
  1. Otitis Media
  2. Persistent Otitis Externa or Periauricular Cellulitis
    1. Severe pain with fever over 101 F
    2. First generation Cephalosporin (Keflex, Duricef)
  3. Necrotizing Otitis Externa
  4. Immunocompromised condition (e.g. Diabetes Mellitus)
Refractory course
1. Consider alternative diagnosis (See above)
2. Consider consultation with Otolaryngology
Complications
1. Necrotizing Otitis Externa
2. Periauricular Cellulitis
3. Ear Canal Furuncle
4. Temporal bone infection <0.5% risk
  1. Requires aggresive care (Life-threatening)
Prevention
1. See Otitis Externa
References

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/16/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.