HEAD, EYE, EAR, NOSE, AND THROATEMERGENCIESEAROtitis Externa (Swimmer’s Ear)
ETIOLOGY
■ Bacterial agents—Pseudomonas aeruginosa, Staphylococcus aureus, Gram-
negative rods
■ Fungal agents—Aspergillus, Candida
■ Increased in divers, swimmers, and regions with high humidity
SYMPTOMS/EXAM
■ External ear pain
■ Pain when tragus/auricle is pulled
■ Localized lymphadenopathy
■ Itching or burning inside the ear canal (especially if fungal)
■ Exudative discharge from the ear canal
■ Conductive hearing loss if severe
TREATMENT
■ Suction and gentle warm irrigation of the canal are indicated.
■ Administer 2% acetic acid solution or alternative drying medication (do not
use if TM is ruptured).
■ Topical antibiotic drops with steroid is first-line therapy (use neomycin/
polymyxin/hydrocortisone otic suspension notsolution if TM ruptured).
■ If TM rupture, consider oral antibiotics (quinolones, cephalosporins, or
penicillinase-resistant penicillins).
■ Consider a wick to facilitate drainage and delivery of antibiotics.
COMPLICATIONS
■ Mastoiditis or other cartilage/bone involvement
■ Meningitis
■ Malignant otitis externa—progression of otitis externa to cause infection
of ear cartilage or osteomyelitis of the skull base (see Figure 14.1):
■ Not a malignancy
■ May see cranial nerve palsies
■ Usually occurs in immunocompromised patients or diabetics
■ P. aeuruginosais the most common cause.
■ Aspergillusis the most common fungal cause.
■ IV antibiotics and admission
Acute Otitis Media
ETIOLOGY
■ Viral is most common.
■ Bacterial agents: Haemophilus influenzae, Streptococcus pneumoniae,
Mycoplasma pneumoniae (bullous myringitis), Moraxella catarrhalis, group A
strep
■ Usually in children <7 years old