Internal Medicine

0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1118 Otitis Externa

OTITIS EXTERNA

STEVEN W. CHEUNG, MD

history & physical

Classification

■Bacterial otitis externa (BOE): swimmer’s ear

■Fungal otitis externa (FOE)

■Chronic otitis externa (COE)

■Malignant otitis externa (MOE): skull base osteomyelitis

History

■Otalgia

■Irritability (in infants)

■Trauma or instrumentation

■Water contamination

■Hearing loss

■Otorrhea

■Vertigo

■Bilateral disease not uncommon

■Diplopia

■Cranial neuropathies (CN 7, 9–12)

Signs & Symptoms

■Tender, painful auricle; worse w/ pinna movements

■Swollen, narrowed external auditory canal (EAC) associated w/ puru-

lent otorrhea & debris

■Periauricular cellulitis in advanced OE

■Otoscopy: hyperemic, macerated skin of EAC w/ overlying skin

debris; TM usually thickened, pts can have concomitant COM

■Cranial neuropathies (CN 7, 9–12) in MOE

tests

■Culture otorrhea in recalcitrant infections

■Temporal bone CT in suspected MOE to determine bony erosion

■Gallium/technetium bone scan in suspected MOE to evaluate for

marrow infection

differential diagnosis

■Perichondritis, furunculosis, carbunculosis, psoriasis & seborrheic

dermatitis of external ear