Overview
Infective otitis externa, commonly known as swimmer's ear, is an inflammatory condition of the external auditory canal caused by bacterial or fungal infections. It often presents with symptoms such as ear pain, discharge, and hearing impairment 1.Diagnosis
Key Diagnostic Criteria: Ear pain exacerbated by tugging on the pinna, presence of otorrhea, redness, swelling of the external auditory canal 1.
Recommended Tests: Otoscopic examination to visualize canal inflammation and debris; tympanic membrane assessment for signs of infection 1.
Grading: Classification systems like the Ceruminous Plug Severity Scale or the Acute Otitis Externa (AOE) grading system can help in severity assessment 1.Management
First-Line Treatments: Topical antimicrobials such as fluoroquinolones (e.g., ciprofloxacin) or aminoglycosides (e.g., gentamicin) 1.
Adjunctive Treatments: Topical corticosteroids to reduce inflammation; consider oral antibiotics if severe or systemic involvement 1.
Dosage/Specifics: Fluoroquinolones typically applied 2-3 times daily; gentamicin often used with a cleaning solution to remove debris 1.Special Populations
Pediatrics: Careful selection of topical agents to avoid systemic absorption; close monitoring for adverse effects 1.
Elderly: Increased vigilance for complications and comorbidities affecting treatment efficacy; consider underlying hearing aids or cerumen impaction 1.
Comorbidities: Patients with diabetes or immunocompromised states may require longer treatment durations and closer follow-up 1.Key Recommendations
Utilize otoscopic examination for accurate diagnosis and grading of infective otitis externa severity 1.
Initiate treatment with topical fluoroquinolones or aminoglycosides for bacterial otitis externa 1.
Incorporate evidence-based medicine (EBM) education to enhance resident competency in managing otitis externa effectively (Evidence: Moderate) 3.
Tailor management strategies for pediatric and elderly patients, considering specific vulnerabilities and potential complications (Evidence: Expert opinion) 1.References
1 Cabrera-Muffly C, Cusumano C, Freeman M, Jardine D, Lieu J, Manes RP et al.. Milestones 2.0: Otolaryngology Resident Competency in the Postpandemic Era. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2022. link
2 Vanstrum EB, Badash I, Wu FM, Ma HJ, Sarode DN, Chambers TN et al.. The Role of Educational Podcast Use Among Otolaryngology Residents. The Annals of otology, rhinology, and laryngology 2022. link
3 Bastaninejad S, Soltani A, Dabiran S, Amali A, Adil S, Borghei P et al.. Determining effectiveness of EBM education in otolaryngology residents using modified fresno test. The Laryngoscope 2019. link
4 Faucett EA, Barry JY, McCrary HC, Saleh AA, Erman AB, Ishman SL. Otolaryngology Resident Education and the Accreditation Council for Graduate Medical Education Core Competencies: A Systematic Review. JAMA otolaryngology-- head & neck surgery 2018. link