High environmental temperatures and trauma leads to a breech in the integrity of the ear canal skin (e.g. cotton buds, fingernails, hearing aids, ear plugs, paperclips, match sticks, mechanical removal of cerumen) (12). Host factors comprise anatomical wax and debris which accumulate and lead to moisture retention (e.g. a narrow ear canal, hairy ear canal). Absence or overproduction of cerumen leads to loss of the protective layer and moisture retention respectively. Chronic dermatological disease (e.g. atopic dermatitis, psoriasis, seborrhoeic dermatitis) is among host risk factors which may lead to OE. Atopic…show more content… Bilateral symptoms (rare)
10. Frequently, a history of exposure to or activities in water (e.g. swimming, surfing, and kayaking)
11. Usually, a history of preceding ear trauma (e.g. forceful ear cleaning, use of cotton swabs, or water in the ear canal)
12. Exposure to local radiotherapy (3,27).
Findings vary between circumscript, diffuse and necrotizing OE. The key physical finding of OE is tenderness upon palpation of the tragus (anterior to ear canal) or application of traction to the pinna (the hallmark of diffuse AOE) (3). Examination reveals erythema, edema, and narrowing of the external auditory canal (EAC), and a purulent or serous discharge may be noted (see the image below) (21). Figure 2. Acute otitis externa. Ear canal is red and edematous, and discharge is present.
Conductive hearing loss may be evident. Cellulitis of the face or neck or lymphadenopathy of the ipsilateral neck occurs in some patients (27). The tympanic membrane may be difficult to visualize and may be mildly inflamed, but it should be normally mobile on insufflations.
Eczema of the pinna may be present. By definition, cranial nerve involvement (i.e. of cranial nerve VII and IX - XII) is not associated with simple OE. Fungal OE results in severe itching but typically causes less pain than bacterial OE does. A thick discharge that may be white or gray is often