OTITIS EXTERNA

This is an infection of the skin of the ear canal. There can be discharge, swelling (narrowing of the canal) and severe pain particularly on pulling the ear or pressing the tragus. In true otitis externa the tympanic membrane is normal.

• Remove as much debris as possible using microsuction (if you are trained to do so). Take a microbiological swab in all cases.


• Antibiotic drops – SOFRADEX 3 drops three times a day. Ask the patient to lie on their bed with the affected the ear pointing up to the ceiling. Put one drop into the ear and vigorously shake the pinna or the tragus for a minute (if pain allows). Then repeat the sequence with another drop and then another, and then lie there for 10 mins. This will allow the drops to enter the deep / medial part of the canal.


• If there is severe canal narrowing inserting a Pope Wick deep into the ear will allow the antibiotic drops to treat the deeper areas of the canal. This is like a very small tampon that will allow the antibiotic drops to seep through it and treat the deeper parts of the ear that aren’t accessible due to the narrowing of the canal.


• In all cases please admit patient to the next available emergency clinic (within 2 days please), as they will need microsuction and close follow up reviews.

Further Reading

eMedicine - Otitis Externa : Article by Kathy A Cook

eMedicine - Otitis Externa : Article by Ariel A Waitzman, MD, FRCSC

wikipedia - Otitis Externa

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OTITIS MEDIA

A bright red tympanic membrane with pain and fever. This is really a GP problem and can be sent home with Amoxicillin (if severe go to Augmentin) and analgesia. No follow up is required in the emergency clinic.

This may later complicate into a perforation where the pain will subside, and you will probably get plenty of discharge from the ear. In this case take a swap and give sofradex drops with analgesia. Ask the GP to review once the infection has gone to make sure that the perforation has healed. If it hasn’t after 6 weeks suggest to the GP to make a outpatient’s appointment to follow this up.

Further Reading

eMedicine - Otitis Media : Article by Kathy A Cook

eMedicine - Pediatrics, Otitis Media : Article by Andrew A Aronson, MD

PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1412-1429 - clinical practice guideline on otitis media with effusion

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