DIFFUSE ACUTE OTITIS EXTERNA

Case Report

Suriya Devi

Parveender Kaur

Paranita Ferronika

Nur Haida Mat Ali

I. IdentityI. Identity

NameName : Ms.A : Ms.A

Sex Sex : Female: Female

Age Age : 27 y.o: 27 y.o

0ccupation 0ccupation : Housewife: Housewife

Address Address : Salakan Selomartani: Salakan Selomartani

M.R number M.R number : 1-27-39-19: 1-27-39-19

II. AnamnesisII. Anamnesis

Chief ComplaintChief Complaint : :Pain on left earPain on left earPresent historyPresent history : :

Since 2 days ago, Ms A felt pain on her left ear Since 2 days ago, Ms A felt pain on her left ear with pulsating sensation accompanied by pain with pulsating sensation accompanied by pain upon palpation on her ear after manipulating her upon palpation on her ear after manipulating her ear with cotton bud. She was experiencing fever. ear with cotton bud. She was experiencing fever.

The was no discharge, itching, hearing loss or The was no discharge, itching, hearing loss or ringing sound. She did not experience flu or cough ringing sound. She did not experience flu or cough prior to her ear pain. No complains on her right prior to her ear pain. No complains on her right ear.ear.

Past HistoryPast HistoryNo history of allergy, asthma and Diabetes Mellitus.No history of allergy, asthma and Diabetes Mellitus.

Family history Family history No family history similar to patient’s complaintNo family history similar to patient’s complaint

III. Resume anamnesis

• History of manipulated ear canal (+)

• Otalgia on the left ear (+)

• Pulsating sensation (+)Pulsating sensation (+)

• Subfebrile (+)Subfebrile (+)

III. PHYSICAL EXAMINATIONIII. PHYSICAL EXAMINATION

GENERAL STATUS : GENERAL STATUS : General condition : Good General condition : Good

ConciousnessConciousness : Compos Mentis : Compos Mentis

VITAL SIGN :VITAL SIGN : Blood Pressure : 120/80 mmHgBlood Pressure : 120/80 mmHg Pulse : 80 x/minPulse : 80 x/min Respiration : 20 x/minRespiration : 20 x/min Temperature : 37,7 degree celciusTemperature : 37,7 degree celcius

External Ear ExaminationExternal Ear ExaminationInspection: Hyperemis (-), Edema (-)Inspection: Hyperemis (-), Edema (-)Palpation: Tragus pain (+), auricular pain (+)Palpation: Tragus pain (+), auricular pain (+)

Neck Examination: Neck Examination: Inspection:Inspection: normalnormalPalpation:Palpation: lymph node enlargement (+)lymph node enlargement (+)

Otoscopic Examination: Otoscopic Examination: Edema (+), narrowing ear canal (+), hyperemia (+)Edema (+), narrowing ear canal (+), hyperemia (+)LOCAL STATUS : See on white boardLOCAL STATUS : See on white board

Diffuse Acute Otitis Externa Sinistra Diffuse Acute Otitis Externa Sinistra

IV. DIAGNOSISIV. DIAGNOSIS

V. TherapyV. Therapy

Ciprofloxacin 2 x 1Ciprofloxacin 2 x 1

Otopain 2 x gtt IIIOtopain 2 x gtt III

Kalium Diclofenac 2 x 1Kalium Diclofenac 2 x 1

VI. Plan

VII. Problem

Control after 3 days

Standard treatment of AOED

THANK YOU

DIFFUSE ACUTE OTITIS EXTERNA

Definition :

An infective dermatitis, usually starting in or near the external auditory canal and sometimes spreading to involve the whole auricle (Gray,1992)

Bacterial infection of the ear canal caused by disruption of normal skin or cerumen barrier due to imbalance of moisture and temperature (Bailey, 2001)

Diffuse inflammation of external ear canal, which may also involve the pinna or tympanic membrane within 48 hours (Rosenfeld et al. 2006)

PATHOGENS COMMONLY ASSOCIATED

• Pseudomonas aeruginosa (20%-60%)

• Staphylococus aureus (10%-70%)

• Staphylococcus epidermides

• Streptococus pyogens

Anatomy of External Ear

HISTOLOGY

High humidity and high temperature

intracellular edema

cartilaginous portion of the stratum corneum absorbs water

cerumen decreases

increases the pH and reduce the water repellent

covering the canal skin

blockage of the apopilosebaceous units

Manipulation of the ear

PATHOPHYSIOLOGY

itcing

proliferation of bacteria inlocally macerated skin

pain ensues as the swollen soft tissue of the canal distract the periosteal lining of the bony canal

purulent discharge begin, the auricle and periauricle soft tissue

may become involved

vulnerable to maceration, allowing bacteria to enter the apopilosebaceous unit

Kryzer TC, Lambert PR, 2000

Linstrom CJ, Lucente FE, Joseph EM , 2001

PREDISPOSING FACTORS

• High humidity and high temperature

• Trauma (Instrumentation and excesscive cleansing of the canal, swimming)

• Individual variation in the anatomy of the canal

• Water quality (in terms of bacterial load)

S5 Rosenfeld et al Clinical Practice Guideline: Acute Otitis Externa

Elements of the diagnosis of diffuse acuteotitis externa

1. Rapid onset (generally within 48 hours) in thepast 3 weeks, AND

2. Symptoms of ear canal inflammation thatinclude:● otalgia (often severe), itching, or fullness,● WITH OR WITHOUT hearing loss or jaw pain,*AND

3. Signs of ear canal inflammation that include:● tenderness of the tragus, pinna, or both● OR diffuse ear canal edema, erythema, orboth● WITH OR WITHOUT otorrhea, regionallymphadenitis, tympanic membrane erythema,or cellulitis of the pinna and adjacent skin

*Pain in the ear canal and temporomandibular joint regionintensified by jaw motion.

S5 Rosenfeld et al Clinical Practice Guideline: Acute Otitis Externa

Classification of

TreatmentTreatment

TREATMENT OTITIS EXTERNA

PreventionPrevention

Water precautionsProphylactic dropsEnvironmental control (eg, hot tubs)Avoiding neomycin drops (if allergic)Addressing allergy to ear molds or water protectorAddressing underlying dermatitisSpecific preventive measures for diabetics or immunocompromised state

(Otolaryngology–Head and Neck Surgery, Vol 134, No 4S, April 2006)

COMPLICATION

• Cellulitis

• Erysipelas

• Perichondritis

• Chondritis

• Chronic non resolving rate