Case Report

DIFFUSE ACUTE OTITIS EXTERNA

Suriya Devi Parveender Kaur

Paranita Ferronika
Nur Haida Mat Ali

I. Identity
Name Sex Age 0ccupation Address M.R number : Ms.A : Female : 27 y.o : Housewife : Salakan Selomartani : 1-27-39-19

II. Anamnesis
Chief Complaint : Pain on left ear Present history : Since 2 days ago, Ms A felt pain on her left ear with pulsating sensation accompanied by pain upon palpation on her ear after manipulating her ear with cotton bud. She was experiencing fever. The was no discharge, itching, hearing loss or ringing sound. She did not experience flu or cough prior to her ear pain. No complains on her right ear.

Past History
No history of allergy, asthma and Diabetes Mellitus.

Family history
No family history similar to patients complaint

III. Resume anamnesis

History of manipulated ear canal (+)

Otalgia on the left ear (+)

Pulsating sensation (+)

Subfebrile (+)

III. PHYSICAL EXAMINATION

GENERAL STATUS : General condition : Good Conciousness : Compos Mentis VITAL SIGN : Blood Pressure : 120/80 mmHg Pulse : 80 x/min Respiration : 20 x/min Temperature : 37,7 degree celcius

External Ear Examination Inspection: Hyperemis (-), Edema (-) Palpation: Tragus pain (+), auricular pain (+) Neck Examination: Inspection: normal Palpation: lymph node enlargement (+) Otoscopic Examination: Edema (+), narrowing ear canal (+), hyperemia (+) LOCAL STATUS : See on white board

IV. DIAGNOSIS

Diffuse Acute Otitis Externa Sinistra

V. Therapy
Ciprofloxacin 2 x 1 Otopain 2 x gtt III Kalium Diclofenac 2 x 1

VI. Plan
Control after 3 days

VII. Problem
Standard treatment of AOED

THANK YOU

DIFFUSE ACUTE OTITIS EXTERNA

Definition :
An infective dermatitis, usually starting in or near the external auditory canal and sometimes spreading to involve the whole auricle (Gray,1992) Bacterial infection of the ear canal caused by disruption of normal skin or cerumen barrier due to imbalance of moisture and temperature (Bailey, 2001) Diffuse inflammation of external ear canal, which may also involve the pinna or tympanic membrane within 48 hours (Rosenfeld et al. 2006)

PATHOGENS COMMONLY ASSOCIATED Pseudomonas aeruginosa (20%-60%) Staphylococus aureus (10%-70%) Staphylococcus epidermides Streptococus pyogens

Anatomy of External Ear

HISTOLOGY

PATHOPHYSIOLOGY
High humidity and high temperature Manipulation of the ear

cartilaginous portion of the stratum corneum absorbs water intracellular edema

blockage of the apopilosebaceous units

cerumen decreases

increases the pH

and reduce the water repellent covering the canal skin

vulnerable to maceration, allowing bacteria to enter the apopilosebaceous unit

itcing

proliferation of bacteria in locally macerated skin

pain ensues as the swollen soft tissue of the canal distract the periosteal lining of the bony canal
Kryzer TC, Lambert PR, 2000 Linstrom CJ, Lucente FE, Joseph EM , 2001

purulent discharge begin, the auricle and periauricle soft tissue may become involved

PREDISPOSING FACTORS
High humidity and high temperature
Trauma (Instrumentation and excesscive cleansing of the canal, swimming) Individual variation in the anatomy of the canal Water quality (in terms of bacterial load)

S5 Rosenfeld et al Clinical Practice Guideline: Acute Otitis Externa

Elements of the diagnosis of diffuse acute otitis externa

1. Rapid onset (generally within 48 hours) in the past 3 weeks, AND

2. Symptoms of ear canal inflammation that include: otalgia (often severe), itching, or fullness, WITH OR WITHOUT hearing loss or jaw pain,* AND 3. Signs of ear canal inflammation that include: tenderness of the tragus, pinna, or both OR diffuse ear canal edema, erythema, or both WITH OR WITHOUT otorrhea, regional lymphadenitis, tympanic membrane erythema, or cellulitis of the pinna and adjacent skin
*Pain in the ear canal and temporomandibular joint region intensified by jaw motion.

S5 Rosenfeld et al Clinical Practice Guideline: Acute Otitis Externa

Classification of

Treatment

TREATMENT OTITIS EXTERNA

Prevention
Water precautions Prophylactic drops Environmental control (eg, hot tubs) Avoiding neomycin drops (if allergic) Addressing allergy to ear molds or water protector Addressing underlying dermatitis Specific preventive measures for diabetics or immunocompromised state
(OtolaryngologyHead and Neck Surgery, Vol 134, No 4S, April 2006)

COMPLICATION
Cellulitis Erysipelas Perichondritis Chondritis

Chronic non resolving rate