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An itchy ear that became painful

BMJ 2009; 339 doi: (Published 16 September 2009) Cite this as: BMJ 2009;339:b3632
  1. Dipan Mistry, specialist registrar,
  2. Helen Atkinson, core trainee 1
  1. 1Ear, nose, and throat department, Hull Royal Infirmary, Hull HU3 2JZ
  1. Correspondence to: D Mistry dipanmistry{at}

    A 23 year old medical student presented with a four week history of an itchy ear that became painful. The patient reported associated hearing 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 oedema and inflammation. As a result, the ear drum could not be seen.


    • 1 What is the likely diagnosis?

    • 2 What are the most likely causative agents?

    • 3 What treatment would you recommend?

    • 4 When is referral to secondary care advised?


    Short answers

    • 1 The diagnosis is acute diffuse otitis externa with cellulitis of the pinna.

    • 2 Pseudomonas aeruginosa and Staphylococcus aureus are the two most likely causative agents.

    • 3 Patients with acute diffuse otitis externa with cellulitis should be treated with …

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