QuestionSBA
QuestionChoice
Acetic acid can be used in the very early stages of infection. In this case, the inflammation, discharge and pain favour using a combination antibiotic/steroid ear drop
32332
e
2% acetic acid ear drops
QuestionChoice
Uncomplicated otitis externa does not require referral to ENT. Persistent infection and infections in which there is concern about spread beyond the external ear canal would warrant referral
32329
b
Urgent referral to ENT
QuestionChoice
Oral antibiotics are usually not used in otitis externa due to poor penetration of the skin that lines the external ear canal. However, if there is spread beyond this (i.e. to bone or face), then oral antibiotics should be considered
32330
c
Oral flucloxacillin
QuestionChoice
Ribbon gauze can be used in severe otitis externa if there is significant inflammation of the ear canal that prevents ear drops from passing into the canal. There is only mild inflammation in this case, making topical antibiotics a better first-line option
32331
d
Insert ribbon gauze (Pope wick)
QuestionChoice
The likely diagnosis is acute otitis externa, given the ear pain and characteristic appearances on otoscopy. Swimming and water sports are common risk factors for this condition. Treatment is with topical antibiotic/steroid drops and keeping the ear dry for 7-10 days
32328
a
Offer topical antibiotic/steroid drops and advise keeping the ear dry
Concept
Chapter
# Summary

Otitis externa, a common cause of otalgia, usually presents with minimal discharge, itch and pain due to acute inflammation of the skin of the external auditory meatus. The most common causative organisms are Pseudomonas species and Staphylococcus aureus. The condition is managed based on its severity, with systemic antibiotics reserved for patients with fever or lymphadenitis. Topical drops may be used for mild to moderate cases, while severe cases may require the use of a ribbon gauze known as “Pope” wicks for the application of topical antibiotics.

# Definition

Otitis externa is an inflammatory condition affecting the skin of the external auditory meatus, often resulting in otalgia. It is characterised by minimal discharge, itchiness and pain.

# Epidemiology

Otitis externa is a common condition, frequently seen in primary care and ENT practices. 

# Aetiology

The most common causative organisms of otitis externa are Pseudomonas species and Staphylococcus aureus.

# Signs and Symptoms

Patients with otitis externa typically present with the following symptoms:

- Otalgia (ear pain)
- Minimal discharge
- Itchiness
- Pain due to inflammation
- Impaired hearing if the meatus becomes blocked by swelling or discharge

[lightgallery]

# Differential Diagnosis

The differential diagnosis for otitis externa includes:

- Otitis media: Characterised by middle ear pain, fever, hearing loss and sometimes discharge.
- Furunculosis: Presents with localised pain, swelling and redness, and occasionally fever.
- Eczema: Features include itching, redness, and scaling of the skin.

# Investigations

The diagnosis of otitis externa is primarily clinical. However, microbiological cultures may be useful in refractory or severe cases to determine the causative organism and guide antibiotic treatment.

# Management

The management of otitis externa depends on the severity:

- Mild to Moderate Otitis Externa: Can be treated with topical drops including combined antibiotic/steroid drops (e.g. Gentamix), acetic acid and other preparations. Patients should be advised to keep the ear dry for the next 7-10 days.
- Severe Otitis Externa: Treated using a strip of ribbon gauze known as “Pope” wicks which can be used for the application of topical antibiotics (classically gentamicin) enabling deeper penetration.
- Indications to Consider Oral Antibiotics: Cellulitis extending beyond the external ear canal, when the ear canal is occluded by swelling and debris and a wick cannot be inserted, and in people with diabetes or compromised immunity with severe infection or high risk of severe infection.

# References

[Click here for NICE CKS on otitis externa](https://cks.nice.org.uk/topics/otitis-externa/)
278
Picture
An example appearance of otitis externa.
1074
Otitis externa.jpeg
images/esq89yyt1665036171699.jpg
images/esq89yyt1665036171699_256.jpg
images/esq89yyt1665036171699_512.jpg
2zgSDYQ/mIZ4l4h0iXiHd1929lA2
275
Otitis Externa
Topic
24
Ear, Nose & Throat
Video
Concept
275
Otitis Externa
614
ZMAGtgf
images/videos/cardiology.png
Quesmed Tutorial: General Practice
6466
Patients with acute otitis externa require topical antibiotic/steroid drops and should be advised to keep the ear dry
A 19-year-old woman presents to her general practitioner (GP) with pain and discharge from her right ear. She reports the symptoms began two days ago after returning from a beach holiday in Spain.

She has no significant past medical history, and her observations are all normal.

On examination, there is tenderness on gentle movement of the right ear. Otoscopy reveals a mildly inflamed and erythematous ear canal with scant white discharge. The tympanic membrane remains intact.

Which of the following is the next best step in management?
a