Practice 10 Minute Consultation

Otitis externa

BMJ 2012; 344 doi: (Published 30 May 2012) Cite this as: BMJ 2012;344:e3623
  1. Liz Walton, general practitioner, research fellow
  1. 1Academic Unit of Primary Medical Care, University of Sheffield, Northern General Hospital, Sheffield S5 7AU, UK
  1. e.walton{at}
  • Accepted 20 March 2012

A 50 year old woman attends with a three day history of irritation, pain, and watery discharge of her right ear. She has just returned from holiday in Spain, where she admits to using her beach towel, artificial nails, and ear buds to try to alleviate itching in her ear.

What you should cover

Points to consider when taking the history:

  • Inflammation of the ear canal with or without infection—This is the definition of acute otitis externa.1 The history above is classic of this condition. If symptoms are recurrent or if they last longer than three months, the condition is classed as chronic otitis externa.1

    • Acute otitis externa can also be classified according to its cause. These are split into three main groups: infective (bacterial, fungal, and viral), non-infective dermatitis (allergic, eczematous, and irritant), and mixed infective and non-infective.2

  • Exacerbating factors—Warm humid climates, swimming, frequent hair washing (especially if in the bath), and insertion of foreign bodies can introduce bacterial infection and cause local trauma to the ear canal, making infection more likely. Prolonged use of hearing aids may also predispose to infection.

  • Over the counter eardrops—Use of over the counter eardrops (such as 2% acetic acid drops) may be helpful in treating mild otitis externa or in its prevention. For patients attending primary care, however, eardrops or sprays containing corticosteroids and acetic acid or antibiotics, or both, have …

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