Otitis externa H60.91

Acute, sub-acute or chronic dermatitis of the auditory canal and auricle.

A distinction is made according to course and cause:

• Otitis externa (infectious)
  • Otitis externa (infectiosa)
    • Bacterial otitis externa
    • Mycotic otitis externa
  • Bathing Botitis
  • Boils of the external auditory canal
• Non-infectious Otitis Externa:
  • Allergic contact dermatitis
  • Atopic dermatitis of the auditory canal
  • psoriasis of the auditory canal
  • Contact allergic otitis externa
  • desiccation dermatitis of the auditory canal
  • Seborrheic dermatitis of the auditory canal
  • Strahlenotitis

Redness, swelling and often itching in the area of the external auditory canal. In case of exacerbation sudden wetting (ear running), possibly accompanied by sensitivity to pressure or spontaneous pain. It is important to clarify the cause (anamnesis, clinic, smear test).

• Acute (bacterial) Otitis Externa: Acute bacterial infection of the external auditory canal.
• Atopic dermatitis of the external ear: atopic diathesis; FA, other manifestations of atopic dermatitis): Often in this constellation there is also a superinfection with Staphylococcus aureus, which can maintain or provoke a dermatitic reaction via exoproteins or superantigens.
• Contact dermatitis of the outer ear: Medical history and history of questionable handling of a contact allergen (e.g. hair dyes, external drugs, aeroallergens).
• Seborrhoeic dermatitis affecting the outer ear: rarely isolated infection of the ear; eminently chronic and recurrent course; resistance to therapy; search for other manifestations of seborrhoeic dermatitis.
• Psoriasis of the auricle: rarely isolated affection of the ear; usually eminently chronic and recurrent course; resistant to therapy; search for other manifestations of seborrheic dermatitis.
• Acute or chronic erysipelas: skin reddened, auricle swollen, painfulness, feeling of illness and lymphadenopathy in acute erysipelas. Laboratory: inflammation parameters reactive!
• Mycosis of the external auditory canal: Anthrophilic pathogens such as T. rubrum may cause an occasionally less inflammatory otitis externa. Cave: usually treated with a Glcocorticoid. Predominant itching, sometimes weeping. Note: Transfer mode through Tinea manis possible! In zoophilic trichophyte-species like T. mentgrophytes and M. canis can be found in the cuddly toy area (ask animal as source of infection! Can be completely asympotmatically diseased!), the typical rim-evoked, centrally faded plaques.
• Impetigo contagiosa: in the case of impetigo caused by group A streptococci (GAS) (especially in small children), cultural evidence of the pathogen should be provided. Clinically mostly weeping, itchy otitis, auditory canal and auricle. Clarify pyoderma on hands! Furthermore, an impetiginized scabies of the hands should be clarified.
• Ostiofollculitis, boils of the outer ear: acute painful, especially pressure painful swelling of the outer ear.
• Rosacea papulo-pustulosa: rare abortive infestation pattern. Chronic course! Mostly recognizable as a partial manifestation of facial rosacea papulo-pustulosa.
• Photoxic otitis: mostly acute dermatological event; phototoxic dermatitis of the face with infection of the auricle. Heliotropic infestation pattern always recognizable. The medical history will show a reference triggering (phototoxic drugs) and light exposure. i
• Polymorphic light dermatosis: Occurrence of an acute/subacute/chronic external titis after strong UV irradiation (especially UVA) of the previously un-tanned skin (spring/holiday). After a latency of days itchy (heliotropic) dermatitis (face + outer ear - it would be unusual if only the skin of the outer ear was affected). Typical are recurring (annual) events.

Clarification and treatment of the causes.

The first priority is the atraumatic cleaning of the auditory canal, as far as the state of swelling allows. Subsequently, disinfectant ear drops on an alcoholic basis R059. These help to reduce the swelling and reach deeper parts of the auditory canal. Gauze strips are inserted to facilitate application (moisten with a few drops every 1-2 hours). In the case of weeping forms, dry with cotton swabs with antiseptic solutions.

If alcoholic bases are too painful on open skin areas, if necessary, disinfectant or antibiotic external preparations in an aqueous solution such as potassium permanganate (light pink), R060 or as ointments/creams such as 1% oxytetracycline (e.g. Jenapharm oxytetracycline eye ointment) or 0.5% oxytetracycline/polymyxin B (e.g. Terramycin eye ointment).

In the case of non-infectious inflammation, glucocorticoid-containing solutions such as betamethasone (e.g. Diprosone solution) 2 times/day. In exceptional cases, combination preparations of antibiotic and glucocorticoid such as betamethasone/ gentamicin (e.g. Diprogenta ointment/cream). Therapy with aqueous disinfectant solutions and gauze strips is left to heal for 2 weeks to prevent recurrence. Moisten 3-4 times daily.

Cave! Clarification of a perforation of the eardrum before treatment!

See also Otitis externa (infectiosa)

In case of severe lymph node swelling or disturbed immune system (e.g. diabetes mellitus), systemic antibiotics may be taken after an antibiotic test.

Initial broad-spectrum antibiotics such as dicloxacillin (e.g. InfectoStaph) 3-4 times/day 2 cps. or ciprofloxacin (e.g. Ciprobay 2 times/day 100-200 mg).