Otitis externa classification

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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

Otitis externa is classified as acute, chronic, or malignant based on the duration of the disease, diffusion of the infection, and the severity of symptoms.

Classification

Otitis externa is classified by duration, diffusion, and symptom severity.

Acute Otitis Externa

• Otitis externa is characterized as "acute" if the following conditions are satisfied:
  • Onset within 48 hours.
  • Primarily caused by bacterial infection of Pseudomonas aeruginosa and Staphylococcus aureus.
  • Otalgia and feelings of itchiness or "fullness" of the ear canal.
  • Erythema or edema of ear canal.
  • Tenderness of the tragus and pinna.
• Hearing loss is not usually associated with acute presentations of otitis externa.
• Acute otitis externa is localized to the ear canal and is not characterized by diffusion of infection throughout the ear and head.

Chronic Otitis Externa

• Otitis externa is considered chronic in cases that persist greater than 3 months with treatment.
  • It is usually diagnosed in cases which antibiotic therapy does not alleviate symptoms.

Malignant Necrotizing Otitis Externa

• Acute otitis externa becomes reclassified as malignant and necrotizing when the infectious pathogen diffuses from the ear canal and infects the temporal bones, as well as bones in the ear adjacent to the canal, leading to damage and degradation.
• It is usually caused by the bacterial pathogen responsible for the acute variant, usually Pseudomonas aeruginosa.
• Otitis externa becomes malignant when the patient is immunocompromised.
  • It usually occurs in acute otitis externa patients with diabetes or undergoing chemotherapy, leading to reduced ability to counter the spread of the pathogen.
• Malignant otitis externa will usually manifest with the following symptoms:
  • Severe otalgia and otorrhea that is not responsive to treatment.
  • Granulated tissue in the ear canal
  • Intracranial and neck complications:
    • Fever
    • Nerve damage in the head and neck.
    • Osteitis
    • Lymphadenitis
    • Difficulty speaking or swallowing.
    • Facial palsy
• Treatment of malignant otitis externa requires therapy targeting the pathogen as well as the source for immunocompromisation.