Internal Medicine

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

Otitis Externa 1119

■Squamous cell carcinoma, adenoid cystic carcinoma, basal cell carci-

noma, melanoma or metastatic carcinoma can present as infections

of EAC

management

■Aural toilet under microscope control

■Antibiotic otic drops to cover Pseudomonas & S aureus in BOE; oral

antibiotics (eg, ciprofloxacin) may be necessary

■Antifungal otic preparations for FOE

■Otic wicks are used to deliver otic antibiotic drops when EAC is

swollen shut.

■Dry ear precautions

■Directed IV antibiotic therapy required to treat MOE

■Otitis externa often requires multiple cleaning sessions; Dx of FOE

vs BOE difficult; MOE often referred to specialist for management

Side Effects

■Neomycin otic drops can cause contact allergy in 6–8% of pts

specific therapy

n/a

follow-up

■Close follow-up critical: untreated OE can progress to MOE (partic-

ularly in diabetics)

■IV antibiotic therapy for MOE

■Follow-up until external canal infection-free

■Return to swimming when EAC makes normal wax

complications and prognosis

Complications

■MOE & skull base osteomyelitis with cranial neuropathies

■Stenosis of EAC

■Cellulitis of face & neck

Prognosis

■Most cases of BOE & FOE are treated effectively w/ meticulous aural

hygiene & antibiotics

■MOE associated w/ worse prognosis & can result in death if not

identified early & treated aggressively