- Acute Otitis Externa is more prevalent in adults
- AOE is a contagious infection that affects the outer eardrum (Gruber et al., 2021)
- Mild forms include external acoustic meatus infections
- Malignant OE has life-threatening symptoms (Wiegand et al., 2019)
- Swimmer’s ear is one encountered conditions in otolaryngology
The Pathogenesis of the Diagnosis of Acute Otitis Externa
- Develops where auditory meatus has robust defense systems
- Blockage results from the skin being inflamed
- Potential risk factors also alleviate the chances of AOE
- Swimming is a well-documented potential risk for AOE
- Dermatologic disorders contribute to the development of AOE
The Clinical Presentation of Acute Otitis Externa
- Otalgia is the most common symptom with 100% prevalence
- Ear discharge accounted for 71%
- Thick white grey with visible hyphae or spores
- External ear edema characterized by swelling accounted for 85%
- External ear inflammations accounted for 57% (Marina et al., 2019).
The History and Physical Exam Findings of Acute Otitis Externa (Wiegand et al., 2019)
- Inspections for erythema on the inner ear
- Tragal pressure is a sign of external otitis
- Tympanic membrane-air fluid level suggests middle ear effusion
- Insufflation is made possible via the pneumatic auriscope
- The eardrum mobility should be present in persons with external otitis.
Other Possible Differential Diagnoses for Acute Otitis Externa (McKean, 2018)
- Otomycosis or external fungal otitis
- Contact dermatitis
- External acoustic meatus canal carcinoma
- Chronic suppurative otitis media
- Psoriasis associated with redness and scaling of external ear canal
The Diagnostic Tests, Screens or Maneuvers of Acute Otitis Externa
- The diagnosis is based upon a physical examination
- Cultures are recommended for extreme cases of AOE
- Severe external otitis requires cultures
- Conductive hearing loss revealed by tuning-fork test
- Where eardrum cannot be visualized, hearing test is conducted (Wiegand et al., 2019)
- The otoscopic assessment is critical for eardrum evaluation
Sensitivity, Specificity, and Predictive Value of the Tests, Screens, or Maneuvers for Acute Otitis Externa
- Nasopharyngeal cultures as putative predictors for AOE
- Audiometric testing, frequency of hearing loss was 79.7%
- Degrees of severity for audiometric testing was positive
- Physical examinations have had positive predictive value
- The otoscopic assessment has a high sensitivity value
- Hearing test has a positive sensitivity and specific values
The Medications that are Prescribed for Acute Otitis Externa (Wiegand et al., 2019)
- 2% Acetic acid otic solution (VoSoL)
- Neomycin otic solutions
- Polymyxin B–hydrocortisone (Otobiotic) prevents neomycin immune responses
- Eardrops with antibiotics, for instance, Ciprofloxacin 2 mg/mL
- The Acetic Acid for general medication is affordable
- Steroid andanalgesic eardrops
The Medications Mechanism of Action
- Acetic acid works by effectively preventing growth of germs
- Neomycin otic solutions suppress bacterial protein synthesis
- Neomycin binds irreversibly to the sensitive bacteria’s 30 S ribosomal subunit
- Polymyxin B–hydrocortisone engages LPS
- Polycationic peptide ring associates with outer membrane of LPS
- Eardrops (Ciprofloxacin) work by preventing bacteria from growing
The Medications Contraindications
- Continuous burning of the ear canal associated with using Acetic Acid Otic Solution to treat an inner ear infection (Otitis Media)
- Tiny white result from taking Neomycin otic solutions with hydrocortisone
- Red lumps on the skin is a result of taking Neomycin with polymyxin
- Adverse effects to topical corticosteroids when Polymyxin B–hydrocortisone is used with occlusive dressings
- Defects to unborn of pregnant women occur when Ciprofloxacin 2 mg/Ml is taken during pregnancy
The Medications Potential Interactions with Food and other Medications
- 2% Acetic acid otic solution (VoSoL) is most likely to interact with food, especially when the victims forget to wash their hands after applying the solution
- Neomycin otic solution and hydrocortisone are often prescribed together
- There are higher chances that Ciprofloxacin 2 mg/mL interacts with food as it can be taken with or without food
- Combining alcohol or smoking with the medications above may also result in interaction
The Medications Patient Education (Wiegand et al., 2019)
- A prolonged prickling sensation in the ear canal is among the side effects
- Dizziness is minimized by making warm the vial of droplets while in the hands prior to use
- When there is no reaction, the care and treatment of the patient should be re-examined closely
- When the external meatus’s self-cleansing process is impaired, the external meatus should be cleaned by a clinician
Prescription for 2% Acetic Acid Otic Solution
- Over the counter, one would purchase 2% Acetic Acid Otic Solution (VoSoL)
- 3-5 drops should be made every 4-6 hours for the ear drop dosage
- After soaking a small piece of cotton in several drops of this remedy, apply it to the ear
- Keep the cotton in the ear for 24 hours and moisten it every 4-6 hours with 3 to 5 drops of acetic acid
- Upon withdrawing the cotton, insert the drips gently into your ear thrice or four times daily
Patient Follow-Up and Education
- In 48–72 hours, the patient’s reaction to treatment is monitored
- To minimize additional infections, identifiable risk conditions be avoided
- Avoid wearing earbuds or in-ear headsets for an extended period
- Avoiding use of cotton buds or your fingers for scratching or cleaning the inside of the ear
- For swimmers, avoid swimming in water that is polluted
References
Gruber, M., Damry, D., Ibrahim, N., Glikman, D., & Ronen, O. (2021). Pediatric acute otitis externa: Characteristics and predictors for the hospital admission. International Journal of Pediatric Otorhinolaryngology, 140, 110-534. Web.
Marina, S., Goutham, M. K., Rajeshwary, A., Vadisha, B., & Devika, T. (2019). A retrospective review of 14 cases of malignant otitis externa. Journal of Otology, 14(2), 63-66. Web.
McKean, S. A. (2018). Acute otitis externa. In ENT Head & Neck Emergencies (pp. 121-126). CRC Press.
Servidoni, A. B., & Conterno, L. D. O. (2018). Hearing loss in the elderly: Is the hearing handicap inventory for the elderly-screening version effective in diagnosis when compared to the audiometric test? International Archives of Otorhinolaryngology, 22(1), 1-8. Web.
Wiegand, S., Berner, R., Schneider, A., Lundershausen, E., & Dietz, A. (2019). Otitis externa: Investigation and evidence-based treatment. Deutsches Ă„rzteblatt International, 116(13), 224. Web.