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Diseases of the External Ear

  1. Normal commensal flora of the external ear
    1. Staphylococcus epidermis
    2. Corynebacterium spp. (diphtheroids)
    3. Staph. aureus
    4. Streptococcus viridians
  2. Middle ear: generally a sterile environment

Inflammatory condition of the external ear

  1. Otitis Externa (O.E.):
    Any inflammation condition of the skin of the external auditory canal
  1. Localized (furunculosis) Bacterial
    • ​​Organism: Staphylococcus aureus
    • Site of affection: Hair - bearing area of the cartilaginous part of the external auditory canal
  2. Diffuse otitis externa
    • ​​Idiopathic
    • Traumatic
    • Irritant
    • Bacterial
    • Fungal
    • Climatic
    • Environmental
    • Viral
  3. Part of generalized skin conditions
    • ​​Seborrhoeic dermatitis
    • ii. Allergic dermatitis
    • Atopic dermatitis
    • iv. Psoriasis
  4. Invasive (malignant O.E.)
  5. Other(Keratosis obturans)

Symptoms                                              Signs
Discomfort and pain                                  Furuncle can be seen in the EAC
Aggravated by jaw/ pinna movement         EAC wall oedema
Deafness if EAC gets occluded                   Tragal sign
Due to the canal oedema                          In contracted cases, there may be surrounding
                                                              cellulitis and regional lymphadenitis
                                                              In severe cases
                                                              Retroauricular sulcus obliteration of the pinna
                                                              Forward displacement of pinna


  1. Local - 10% Icthymol glycerin pack
  2. Oral antibiotics if local cellulitis presents
  3. Oral analgesics
  4. Incision and drainage à if boil not drained within 24- 48 hrs
  5. In recurrent furunculosis:
    1. Do culture/sensitivity
    2. Rule out diabetes mellitus
    3. Examine the nasal vestibule
    4. Rule out skin infection
​​Diffuse Otitis Externa:

[tropical ear/Singapore ear/Swimmer’s Ear]

  1. Organisms:
    1. Pseudomonas aeruginosa ­Sweat changes ph of EAC skin to alkaline
    2. Bacillus proteus
    3. Staphylococcus aureus

Acute type                                                          Chronic type                          
Signs and symptoms                                          Symptoms/Sign                   
a. Similar to furunculosis                                      a. Irritation in the Ear        
b. Thin serous ooze becomes thick and                   b. Constant desire to itch purulent                                                                                      c. Scanty’ discharge in the EAC
c.  Sealing & fissures in the canal wall                    d  Dried crusts

  1. Treatment
    1. Ear toileting with mopping/duct clearance/irrigation
    2. Keep ear clean and dry
    3. Medicated wicks (Antibiotics + steroids]/ I.G pack in chronic case too
    4. Oral Antibiotic
      1. Cellulitis (if skin chronically thick despite adequate medical T/t surgery)
      2. Lymphadenitis
    5. Analgesics (NSAIDS)
    6. Topical antibiotics with steroid cream (e.g. Neosporin-H)
  2. Otomycosis
    1. Organisms
      • Aspergillus niger
      • A. fumigatus
      • Candida albicans
      • Dermatophytes
      • Actinomyces
    2. Symptoms
      • Itching
      • Pain
      • Deafness
    3. Sign - Wet blotting paper appearance mousy/ musty odor
    4. Treatment: Suction clearance, keep ear clean and dry
      i. Antifungal ear drops
      Gentian violet -27% salicylic acid in alcohol is a keratolytic
      (Treatment to be continued for I week after apparent cure of the disease)
  3. Bullous Myringitis
    1. Otitis externa Haemorrhagica = Myringitis Bullosa = Myringitis Bullosa Haemorrhagica = Bullosa Myringitis
    2. Organism: Viral (Influenza epidemics)
    3. Feature:
      1. Haemorrhagic blebs on the lateral surface of the tympanic membrane and the skin of the EAC
      2. Severe pain, blood stained d/s
      3. Treatment:
        • ​​Analgesics
        • Antibiotic: only if secondary ear infection
        • Blebs NOT to be incised​

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