TARGET AUDIENCEPhysicians, nurse practitioners, and physician assistants who evaluate and care for children with minor illnesses.Specialists including pediatricians, emergency physicians, pediatric emergency physicians, family practitioners, otolaryngologists, pediatric nurse practitioners, and nurses working in school or camp setting will find this information particularly useful.
LEARNING OBJECTIVESAfter completion of this article, the reader will be able to: 1. Define the pathogenesis and microbiology of otitis externa. 2. Describe the presenting sign and symptoms in children with infections of the external ear, as well as the complications. 3. Discuss the therapeutic options, including topical antibiotic drugs, anti-inflammatory agents, and the use of mechanical interventions (wick, ear plugs).
DEFINITIONO titis externa (OE), also known as ''swimmer's ear''or ''tropical ear,'' is a disease process that includes infection or inflammation of the external ear canal. It can range from mild inflammation to a very severe disease process known as necrotizing otitis externa. It is caused by a break in the normal skin/cerumen protective barrier in the external ear canal usually under the conditions of elevated humidity and warmer temperature.Three clinical stages of OE have been described: preinflammatory, acute inflammatory, and chronic. The preinflammatory stage results from moisture or local trauma in the ear canal. The skin becomes edematous, obstructing the glands. This process predisposes the ear to further trauma. The acute inflammatory stage of OE can be classified into mild, moderate, and severe stages. In the mild acute inflammatory stage, the canal is erythematous and edematous, and develops clear odorless secretions. Moderate acute inflammatory OE has increased edema and pain, and the secretions become seropurulent. Severe inflammatory OE is intensely painful and involves a lumen that is obstructed with draining secretions and debris. It is often accompanied with periauricular edema and adenopathy. If the infection spreads to surrounding tissues, the condition is known as necrotizing OE. Finally, chronic OE is defined as a single episode lasting longer than 4 weeks or 4 or more episodes in 1 year. 1