Otitis externa (adult)
Otitis externa is inflammation of the external auditory canal, auricle and outer surface of the tympanic membrane. It can be localised or diffuse, acute or chronic. It is typically caused by Staphylococci or Pseudomonas organisms. Features classically include an acute-onset itch, otalgia, otorrhoea (creamy) and mild hearing loss. The pinna can be inflamed and is usually always extremely tender on gentle movement. This pain, in addition to an inflamed and narrowed canal, will make otoscopy difficult.
A detailed history may reveal predisposing factors such as underlying skin conditions (e.g. eczema, psoriasis), use of cotton ear buds, and warm and moist conditions. Ear swabs should be taken to help guide antibiotic therapy, which are usually given as topical drops or spray. In addition, it may be appropriate to use analgesia, aural toilet (for severe cases and complications), IV antibiotics (systemic symptoms), and petrosectomy (in some cases of malignant otitis externa)