Recognize the clinical manifestations and appropriate treatment of otitis externa and   malignant external otitis  

 

Explanation:

Otitis externa is a common problem and is usually treated topically but its rarer counterpart:  malignant otitis externa needs parenteral antibiotics aimed at Pseudomonas.

Otitis externa is associated with the tragus sign where -if you push or pull the external ear gently - you elicit pain.

As the skin and cartilage of the external ear are so tightly held together - the swelling tries to rip these two apart and thus is responsible for the pain associated with the condition.

Pain relief along with swelling relief is key to treatment-commonly used preparations include combo of hydrocortisone with neomycin/polymyxin..

If the inflammation becomes obvious on the pinna and is no longer restricted to the ear canal - 2 diagnoses should come to mind

1. Malignant otitis externa(MOE)  or
2. Relapsing polychondritis (RP).

MOE will be suggested by the presence of Immunosuppression/Diabetes/malignancy - all of which predispose to MOE. Findings include unbearable pain and pus discharge ( If there is pus but no pain - think otitis media with ruptured tympanic membrane). 

MOE is treated IN HOSPITAL with IV antipseudomonal antibiotics (Ciprofloxacin/Ceftazidime/Antipseudomonal penicillins-Ticarcillin)and usually requires surgical debridement too (unless it is very early) .

RP on the other hand is suggested by another cartilage being affected or prior history of the problem. This could be the nasal or laryngeal cartilages and is treated with steroids. These patients can go into laryngeal stridor but need not be admitted if there is no suggestion of it.