Acute Otitis Externa

Publication Date: February 1, 2014

Key Points

Key Points

  • Acute otitis externa (AOE) is a cellulitis of the ear canal skin and subdermis, with acute inflammation and variable edema.
  • Also known as swimmer’s ear or tropical ear, AOE is one of the most common infections encountered by clinicians, with regional variations based on age and geography.
  • In 2007 there were about 2.4 million visits to ambulatory care centers and emergency departments for AOE (8.1 visits per 1000 population), affecting 1 in 123 persons in the United States.
    • Just less than half of all visits were for children 5-14 years of age.
    • Lifetime incidence is up to 10%.
    • AOE is more common in regions with warmer climates, increased humidity, or increased water exposure from swimming.
    • Nearly all (98%) AOE in North America is bacterial.
  • The etiology of AOE is multifactorial.
    • Regular cleaning of the ear canal removes cerumen, which is an important barrier to moisture and infection.
    • Debris from dermatologic conditions may also encourage infections, as can local trauma from attempts at self-cleaning, irrigation, and wearing hearing aids.
    • Other factors such as sweating, allergy, and stress have also been implicated in the pathogenesis of AOE.
  • The most common pathogens are Pseudomonas aeruginosa (20%-60% prevalence) and Staphylococcus aureus (10%-70% prevalence), often occurring as a polymicrobial infection.
  • Topical antimicrobials are beneficial for AOE, but oral antibiotics have limited utility.

Diagnosis

...gnosis

...ments of the Diagnosis of Diffuse Acute Otitis Ex...


...le 2. Summary of Evidence-based State...

...ntial diagnosisClinicians should distin...

...fying factorsClinicians should assess the...

...nagementClinicians should assess patients wi...

...robialsClinicians should NOT prescr...

...ical therapyClinicians should use topical prep...

...iveryClinicians should instruct pati...

...onintact tympanic membraneWhen the patient...

...essmentIf the patient fails to respond to...


Figure. Managing AOE

...igure. Managing AOE

Table 3. Common Topical Otic Preparations Approved by the Food and Drug Administration for Treating Diffuse AOE

...3. Common Topical Otic Preparations Appr...

Table 4. Instructions for Patients

...ctions for PatientsHaving trouble viewing tabl...

Table 5. Patient Information for Topical Therapy of AOE

...ent Information for Topical Therapy o...