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{{Otitis externa}}
{{Otitis externa}}
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==Overview==
Physical examination of the [[ear canal]] will reveal findings indicative of acute, chronic, and malignant necrotizing otitis externa. For acute otitis externa, the patient can appear ill if the cause is infectious and is accompanied by [[fever]]. Patients with chronic otitis externa are usually well-appearing. Malignant necrotizing otitis externa patients are usually ill-appearing due to the accompanying [[fever]] and [[facial palsy|facial palsies]].


==Physical Examination==
==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]].
===HEENT and Neck===
<div align="left">
*The following physical exam findings in the [[ear canal]] are indicative of otitis externa:<ref name="pmid23198673">{{cite journal |vauthors=Schaefer P, Baugh RF |title=Acute otitis externa: an update |journal=Am Fam Physician |volume=86 |issue=11 |pages=1055–61 |year=2012 |pmid=23198673 |doi= |url=}}</ref>
<gallery heights="175" widths="175">
**[[Erythema]] and [[edema]].
Image:Otitis Externa Oct2004 044 2 op .jpg|[[Boil]] ([[furuncle]]) occluding the right [[external auditory meatus]].<ref>http://www.ghorayeb.com</ref>
**[[Tenderness]] of the [[tragus]] and [[auricle]].
Image:Otitis Externa GG .jpg|Otitis externa.<ref>http://www.ghorayeb.com</ref>
**[[Cellulitis]] of the [[auricle]] and [[ear canal]].
</gallery>
**[[Otorrhea]]
</div>
**[[Granulation tissue]]
**[[Stenosis]] of the [[ear canal]].
**Buildup of [[otomycosis|mycotic]] debris.<ref name="pmid21625307">{{cite journal |vauthors=Viswanatha B, Naseeruddin K |title=Fungal infections of the ear in immunocompromised host: a review |journal=Mediterr J Hematol Infect Dis |volume=3 |issue=1 |pages=e2011003 |year=2011 |pmid=21625307 |pmc=3103236 |doi=10.4084/MJHID.2011.003 |url=}}</ref>
**Lack of [[cerumen]].
*In the neck, [[lymphadenitis]] may be present in acute otitis externa.<ref name="pmid24421666">{{cite journal |vauthors=Hui CP |title=Acute otitis externa |journal=Paediatr Child Health |volume=18 |issue=2 |pages=96–101 |year=2013 |pmid=24421666 |pmc=3567906 |doi= |url=}}</ref>
*In malignant necrotizing otitis externa, the patient may present signs of [[trismus]] and partial [[facial palsy]].<ref name="pmid12892351">{{cite journal |vauthors=Handzel O, Halperin D |title=Necrotizing (malignant) external otitis |journal=Am Fam Physician |volume=68 |issue=2 |pages=309–12 |year=2003 |pmid=12892351 |doi= |url=}}</ref>


<div align="left">
===Appearance of the Patient===
<gallery heights="175" widths="175">
*For acute otitis externa, the patient can appear ill if the cause is infectious and is accompanied by [[fever]].<ref name="urlMalignant otitis externa: MedlinePlus Medical Encyclopedia">{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/000672.htm |title=Malignant otitis externa: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
Image:Otitis Externa .jpg|Magnified picture of the [[furuncle]]. Note the complete occlusion of the external auditory meatus, the redness and the crusted exudate.<ref>http://www.ghorayeb.com</ref>
*Patients with chronic otitis externa are usually well-appearing.
Image:Allergy to Neomycin 350 SQ.jpg|Allergic otitis externa, a reaction to [[Neomycin]]. The skin of the external auditory meatus, concha, incisura intertragica is swollen, bumpy and itchy.<ref>http://www.ghorayeb.com</ref>
*Malignant necrotizing otitis externa patients are usually ill-appearing due to the accompanying [[fever]] and [[facial palsy|facial palsies]].<ref name="pmid12892351">{{cite journal |vauthors=Handzel O, Halperin D |title=Necrotizing (malignant) external otitis |journal=Am Fam Physician |volume=68 |issue=2 |pages=309–12 |year=2003 |pmid=12892351 |doi= |url=}}</ref>
</gallery>
</div>


<div align="left">
==Key Examples of Otitis Externa Physical Findings==
<gallery heights="175" widths="175">
<gallery>
Image:AURICLEDERMATITISG.jpg|Otitis externa and [[seborrheic dermatitis]].<ref>http://www.ghorayeb.com</ref>
Image:OtitisExterna001.jpg|A severe case of acute otitis externa.  Note the narrowing of the external auditory channel, the prominent amounts of [[exudate]] and swelling of the [[Pinna (anatomy)|auricle]]. Case presented by James Heilman, MD.
Image:Seborrheic Dermatitis and Otitis Externa op.jpg|Otitis externa and [[seborrheic dermatitis]].<ref>http://www.ghorayeb.com</ref>
Image:OtitisExterna002.jpg|A mild case of otitis externa. Case presented by Klaus D. Peter.
</gallery>
</gallery>
</div>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Needs overview]]
[[Category:Primary care]]
[[Category:Primary care]]
[[Category:Disease]]
[[Category:Disease]]

Revision as of 16:58, 18 May 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

Physical examination of the ear canal will reveal findings indicative of acute, chronic, and malignant necrotizing otitis externa. For acute otitis externa, the patient can appear ill if the cause is infectious and is accompanied by fever. Patients with chronic otitis externa are usually well-appearing. Malignant necrotizing otitis externa patients are usually ill-appearing due to the accompanying fever and facial palsies.

Physical Examination

HEENT and Neck

Appearance of the Patient

  • For acute otitis externa, the patient can appear ill if the cause is infectious and is accompanied by fever.[5]
  • Patients with chronic otitis externa are usually well-appearing.
  • Malignant necrotizing otitis externa patients are usually ill-appearing due to the accompanying fever and facial palsies.[4]

Key Examples of Otitis Externa Physical Findings

  • A severe case of acute otitis externa. Note the narrowing of the external auditory channel, the prominent amounts of exudate and swelling of the auricle. Case presented by James Heilman, MD.

    A severe case of acute otitis externa. Note the narrowing of the external auditory channel, the prominent amounts of exudate and swelling of the auricle. Case presented by James Heilman, MD.

  • A mild case of otitis externa. Case presented by Klaus D. Peter.

    A mild case of otitis externa. Case presented by Klaus D. Peter.

References

  1. ↑ Schaefer P, Baugh RF (2012). "Acute otitis externa: an update". Am Fam Physician. 86 (11): 1055–61. PMID 23198673.
  2. ↑ Viswanatha B, Naseeruddin K (2011). "Fungal infections of the ear in immunocompromised host: a review". Mediterr J Hematol Infect Dis. 3 (1): e2011003. doi:10.4084/MJHID.2011.003. PMC 3103236. PMID 21625307.
  3. ↑ Hui CP (2013). "Acute otitis externa". Paediatr Child Health. 18 (2): 96–101. PMC 3567906. PMID 24421666.
  4. ↑ 4.0 4.1 Handzel O, Halperin D (2003). "Necrotizing (malignant) external otitis". Am Fam Physician. 68 (2): 309–12. PMID 12892351.
  5. ↑ "Malignant otitis externa: MedlinePlus Medical Encyclopedia".

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