Sandbox: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, as well as diffusion and severity of infection and 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:[1]
- Hearing loss is not usually associated with acute presentations of otitis externa.[1]
- Acute otitis externa is treated with topical or systemic antibiotics for 7-10 days.
- Clinical response will usually be seen within 48-72 hours; full symptom resolution is usually achieved within 14 days.
- 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 for cases that persist greater than 3 months with treatment.[1]
- Usually, it is diagnosed for cases in which antibiotic therapy does not alleviate symptoms.
- Chronic otitis externa is primarily caused by the following:
- Otomycosis, particularly by Candida albicans and Aspergillus niger
- Allergic rhinitis
- Underlying dermatoses:
- Symptoms of chronic otitis externa are predominantly itching, due to the presence of dermatalogical condition or fungal debris.
- Otorrhea is more common in chronic otitis externa than the acute presentation.
- Treatment of chronic otitis externa resolves around treating the underlying condition, including corticosteroid therapy for dermatological conditions and topical anti-fungal medications for otomycosis.[3]
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.[4][5]
- 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.
References
- ↑ 1.0 1.1 1.2 1.3 Hui CP (2013). "Acute otitis externa". Paediatr Child Health. 18 (2): 96–101. PMC 3567906. PMID 24421666.
- ↑ Schaefer P, Baugh RF (2012). "Acute otitis externa: an update". Am Fam Physician. 86 (11): 1055–61. PMID 23198673.
- ↑ Yaganeh Moghadam A, Asadi MA, Dehghani R, Zarei Mahmoudabadi A, Rayegan F, Hooshyar H, Khorshidi A (2010). "Evaluating the effect of a mixture of alcohol and acetic acid for otomycosis therapy" (PDF). Jundishapur J Microbiol. 3 (2): 66–70.
- ↑ Handzel O, Halperin D (2003). "Necrotizing (malignant) external otitis". Am Fam Physician. 68 (2): 309–12. PMID 12892351.
- ↑ "Malignant otitis externa: MedlinePlus Medical Encyclopedia".