Otitis externa

Case report:

A 45 year old patient with a history of alcohol comes into practice and complains of severe pain in the left external auditory meatus. The pain has increased significantly in intensity in the past 48 hours and are pulsating character. They radiate in the temple and the left upper jaw. Furthermore, there are a fever for three days, and a very significant impairment of their general condition. It should also be flown from the ear a yellowish, unpleasant-smelling liquid. A major limitation of the hearing had not occurred. The study shows an extremely painful ear pressure and a phlegmonous inflammation of the entire external auditory canal, starting from a boil in the ear canal front wall. There is no tenderness of mastoid.

Comment:

This characteristic clinical findings is an otitis externa circumscripta that in unfavorable gradients cause abszedierendem infestation of retroauricular lymph nodes with the image of Pseudomastoiditis. Complications caused by a septic metastasis or lymphatic spread, for example, in the meninges. This form of otitis externa must of otitis externa maligna - be distinguished as they may occur especially in diabetics - also called necrotizing otitis externa. Here, there is a painful swelling of the ear canal soft tissue with the transition to a granulation process, which can damage the cortical bone. This leads to osteomyelitis of the temporal bone and / or base of the skull. When spread to the jugular foramen magnum or paresis of cranial nerves IX-XII may occur. The cranial nerves IV-VIII may be affected with symptoms such as dizziness, numbness, trismus.

Therapy:

A specific example suppuration in the form of a furuncle must be incised. When otitis externa circumscripta staphylococci or streptococci are usually detectable as excitation means swab so that antibiotic a systemische therapy of flucloxacillin (STAPHYLEX), macrolide antibiotics [eg Azithromycin (ZITHROMAX)], clindamycin (SOBELIN) or oral cephalosporins [eg Cefalexin (CEPHALEX) oderLoracarbef (LORAFEM)] should be used. It must be noted that in some newer oral cephalosporins sufficient activity against staphylococci is. Local gauze can be inserted with Ichthyol Ointment, after boil-emptying a regular ear cleaning and disinfection should take place. As a general treatment analgesics and / or anti-inflammatory drugs may be administered; moist, warm associations and red light are often perceived as pleasant.
When otitis externa maligna has to be considered as a dominant pathogen Pseudomonas aeruginosa. In addition to a generous incision and ablation of the focus of infection, therefore must be a Pseudomonas-effective therapy for example, Piperacillin (PIPRIL etc.) in combination with aminoglycosides [eg Tobramycin (GERNEBCIN)] or high-dose ciprofloxacin (Cipro) done.