An itchy ear that became painful

doi:10.1136/bmj.b3632

Published 16 September 2009, doi:10.1136/bmj.b3632
Cite this as: BMJ 2009;339:b3632

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An itchy ear that became painful

Dipan Mistry, specialist registrar, Helen Atkinson, core trainee 1

¹ Ear, nose, and throat department, Hull Royal Infirmary, Hull HU3 2JZ

Correspondence to: D Mistry dipanmistry@hotmail.com

The first 150 words of the full text of this article appear below.

A 23 year old medical student presented with a four week historyof an itchy ear that became painful. The patient reported associatedhearing loss, and there was scanty offensive smelling otorrhoea.On examination the pinna was red, warm, and mildly tender (fig).The external auditory canal lumen was narrowed owing to oedemaand inflammation. As a result, the ear drum could not be seen.

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1 What is the likely diagnosis?

2 What are the most likelycausative agents?

3 What treatment would you recommend?

4When is referral to secondary care advised?

1 The diagnosis is acute diffuse otitis externa with cellulitisof the pinna.

2 Pseudomonas aeruginosa and Staphylococcusaureus are the twomost likely causative agents.

3 Patientswith acute diffuse otitis externa with cellulitisshould betreated with oral flucloxacillin, antimicrobial eardrops(suchas hydrocortisone and gentamicin drops), and oral analgesics.

4 Referral to secondary . . . [Full text of this article]