Otitis Externa


What is Otitis Externa?

The inflammatory and infectious condition occur in the external auditory canal and/ or auricle is termed as Otitis externa (OE).

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This condition arises in all age groups1.

Types of Otitis externa

The different types of Otitis externa are bellow:

Acute diffuse Otitis externa

This type of  Otitis externa is chiefly present in swimmers.


Acute localized Otitis externa (furunculosis)

This type of OE is related with infection of a hair follicle.

Chronic Otitis externa

Prolonged period  means almost continuous more than six months period of  Acute diffuse Otitis externa is termed as Chronic Otitis externa.

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Eczematous or eczematoid Otitis externa

Different types of skin related problems, such as psoriasis, atopic dermatitis, eczema and systemic lupus erythematosus are affected external auditory canal.

Malignant (necrotizing) Otitis externa

Immunocompromised adults like diabetics, patients with AIDS may extend infection into the adjacent deeper tissues of the external auditory canal.

Otomycosis

Fungal species cause infection, which is spread to the ear canal, for example Candida, Aspergillus.

Symptoms of Otitis externa

The key symptoms of Otitis externa are a pain in the anterior to the ear canal and also traction to the pinna.

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Other than these, the following are the sign and symptoms:

  • The pain range of Otalgia extends from mild to severe gradually  increasing within 1 to 2 days.
  • Temporary loss of hearing in the acute case, but it may extend to permanent hearing difficulty in the chronic case.
  • Feeling of increased pressure inside the ear due to fluid accumulation
  • The external auditory canal becomes narrowing
  • Ringing sensation inside the ear or tinnitus
  • Occasional fever
  • Itching sensation develops particularly in chronic otitis externa or infectious fungal Otitis externa
  • In the case of malignant otitis externa, immuno-compromised patients have severe deep pain.
  • The secreted discharge has a foul smell and initially the nature of the discharge is clear, but in chronic case gradually it becomes purulent.
  • In rare cases,  lymphadenopathy of the ipsilateral neck (glands around the ear or in the neck can become enlarged and sore) or cellulitis of the face or neck.
  • In certain cases, symptoms develop bilaterally.

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Cause of Otitis externa

One of the common dermatological infection in the ear is Otitis externa. Usually the onset of the infection is sudden without prior intimation. Commonly, the causative organism is bacteria or other germs like fungus or yeast.

Some individuals are more vulnerable towards Otitis externa. Water, soap, shampoo and hairspray etc. entrance into the ear canal may cause itching. The ear becomes injury during poking or scratching with sharp thing entering into the ear canal. The internal skin injury of the eardrum cause swelling. This is sensitive towards infection and develops a brutal area in the external auditory canal. Infection and selling cause itching and to do so worsen the condition further.

Other feasible reasons of otitis externa


  • The prolonged exposure or water activities, similar as in swimming. Therefore, swimmers are often getting Otitis externa than non-swimmers. In this instance, Otitis externa is also known as swimmer’s ear.
  • The climate also influences the incidence rate, usually in hot weather the humid and excessive perspiration cause otitis externa.
  • Psoriasis or eczema may involve the ear canal and that causes an otitis externa.
  • Erroneous way to cleansing earwax which hurt and irritate the ear canal cause swelling.
  • Infection in the middle ear also cause discharge from the ears and also cause otitis externa.

Treatment of otitis externa

Usually the specific diagnosis is not recommended for otitis externa, as physical examination of the ear can detect the case.

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Image – Diagnostic and Management Chart of Otitis externa

But sometimes, doctor prefer to do culture test of the discharge to identify the infectious agent.

Usually OTC product like EarCalm®, which contains 2% acetic acid can be used as self-medication for treating otitis externa. But, this is not advisable for all the cases, as a causative organism for otitis externa requires specific antibiotic treatment. Different types of antibiotic drops are available for treating otitis externa.

Antibiotic Ear drops or sprays

Depending upon the germ, the doctor usually prescribes ear drops or ear spray for the easy self-application. neomycin and  clioquinol are most frequently prescribed antibiotics.

Steroidal ear drops

Steroidal ear drops also prescribe for controlling swelling and irritation.

Different combination therapy of steroids and antibiotics are available, which often use for otitis externa. The combined therapy may prescribe for a week to completely eradicate the infection. Some cases, dose alteration or medication alteration requires for unresponsive cases.

Administration process of ear drops

  • Lie down inside position  with keeping the ear at the upward position.
  • Put ear drops into the ear canal according to the physician direction and maintains the same lie-down position for one to two minutes.
  • During this time, front cartilage pressed for few seconds for enlarging the canal size and helps to the proper administration of drug inside the canal.

Some Precautionary Measures

Do not put cotton swab inside the ear canal, because it can cause accumulation of fluid into the ear canal.

Cotton wool can be used for mopping the discharge and it has been instructed that always use fresh cotton wool for cleaning purpose.

Analgesic

Analgesic like ibuprofen, paracetamol are use for controlling pain. Even some hot compression also helps to reduce pain.

Prevention from otitis externa

Otitis externa sensitive patients require some preventive measures and even this is applicable to every individual:

  • During bathing or taking shower caution should take to avoid soap or shampoo entrance into the ear canal.  The precautionary measure also requires for water lodging.
  • Do not put any foreign object into the ear for cleaning purpose.
  • Towel corner or cotton buds application  for dry up the ear is not required, it may cause deep insertion, as they push the water inner side. Natural drying is advisable.
  • During swimming or other water activity wears a shower cap for preventive measure.

ICD-9 Code

Acute otitis externa NEC is coded under ICD 9. Otitis externa coded ICD-9-CM 380.22 is billable medical code, which can apply for a reimbursement claim. This code is specifically applicable to get a service on or before September 30, 2015.

After this period, the ICD-10-CM code is equivalent and applicable for claiming purpose. Recently the code version is revised and amended code versions are ICD-9-CM 380.22: 2013 2014 2015.

Pictures

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References

  1. Ariel A Waitzman (2016); Otitis Externa; Retrieve from: http://emedicine.medscape.com/article/994550-overview
  2. Ear Infection (Otitis Externa); Retrieve from:  http://patient.info/in/health/ear-infection-otitis-externa
  3. ROBERT SANDER (2001); Otitis Externa: A Practical Guide to Treatment and Prevention; Retrieve from: http://www.aafp.org/afp/2001/0301/p927.html
  4. 2012 ICD-9-CM Diagnosis Code 380.22; icd9data.com; Retrieve from: http://www.icd9data.com/2012/Volume1/320-389/380-389/380/380.22.htm

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