Otitis externa physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Physical Examination

When the physician looks in the ear, the canal appears red and swollen in well-developed cases of acute external otitis. The ear canal may also appear eczema-like, with scaly shedding of skin. Touching or moving the outer ear increases the pain, and this maneuver on physical exam is very important in establishing the clinical diagnosis. It may be difficult for the physician to see the eardrum with an otoscope at the initial examination because of narrowing of the ear canal from inflammation and the presence of drainage and debris. Sometimes the diagnosis of external otitis is presumptive and return visits are required to fully examine the ear. The diagnosis may be missed in early cases because the examination of the ear, with the exception of pain with manipulation, is normal or nearly normal. In some cases of early external otitis, the most striking visual finding in the ear canal is the lack of cerumen. As a moderate or severe case of external otitis resolves, weeks may be required before the ear canal again shows a normal amount of cerumen.

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  Boil (furuncle) occluding the right external auditory meatus.

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  Otitis externa.

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  Magnified picture of the furuncle. Note the complete occlusion of the external auditory meatus, the redness and the crusted exudate.

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  Allergic otitis externa, a reaction to Neomycin. The skin of the external auditory meatus, concha, incisura intertragica is swollen, bumpy and itchy.

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  Otitis externa and seborrheic dermatitis.

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  Otitis externa and seborrheic dermatitis.