Otitis externa is inflammation of the external ear canal and is normally caused by a bacterial infection although fungal infections can happen especially in patients who have had multiple courses of antibiotics for their otitis externa.
The symptoms are pain and discharge which happen together as opposed to acute otitis media where you get pain and then discharge if the tympanic membrane ruptures when the pain settles. The hearing may well be muffled and there is often preceding or associated itching of the ear.
Examination shows an inflamed tender ear canal often with discharge. Unlike otitis media, otitis externa is not related to mastoiditis so if you are confident about the diagnosis of otitis externa any swelling/tenderness in the region of the mastoid is likely to be due to a post auricular lymph node and of no significance.
The infection is in the skin of the ear canal and oral antibiotics are only able to achieve low concentration levels in this area compared to topical treatment and should therefore normally be avoided in favour of ear drops or spray.
Patients who have not responded to primary care treatment – refer via SCI Gateway.
Patients with ongoing hearing loss after treatment of the otitis externa – refer via SCI Gateway.
Patients who have developed an associated cranial nerve palsy(normally facial nerve) - refer same day to the Emergency Department with an email to ENT@borders.scot.nhs.uk.
Patients who are systemically unwell – refer same day to the Emergency Department with an email to ENT@borders.scot.nhs.uk.
Advise patients to
Microbiology swab of ear discharge if not responding to topical antibiotic treatment, immunocompromised or systemically unwell.
Treat topically – see Eastern Region Formulary.
If there are concerns about a perforation or failure to respond to initial treatment try ciprofloxacin/dexamethasone 4 ear drops X2/day for a week.
For recurrent otitis externa where there is regular itching of the ear and/or dry scaly skin treat the itching/skin changes with a topical steroid such as synalar gel 0.025% at night for 5 days.
Borders Ref Help Toolkit