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Otitis Externa

Otitis Externa is a topic covered in the 5-Minute Emergency Consult.

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  • Inflammation or infection of the auricle, auditory canal, or external surface of the tympanic membrane (TM):
    • Spares the middle ear
    • Affects 4/1,000 persons in US
  • Also called “swimmer's ear” due to the usual history of recent swimming:
    • Occasional cases after normal bathing
  • Necrotizing (malignant) otitis externa:
    • Infection starts at the ear canal and progresses through periauricular tissue toward the base of the skull
    • Occurs in elderly, diabetic, or other immunocompromised patients
    • Caused by Pseudomonas aeruginosa
    • Can lead to cellulitis, chondritis, and osteomyelitis
    • Associated with 20% mortality


  • Often precipitated by an abrasion of the ear canal or maceration of the skin from persisting water or excessive dryness
  • Predisposing factors include:
    • History of ear surgery or TM perforation
    • Narrow or abnormal canal
    • Humidity
    • Allergy
    • Eczema
    • Trauma
    • Abnormal cerumen production
  • P. aeruginosa, Staphylococcus aureus, streptococcal species, and rarely fungi

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Rosen, Peter, et al., editors. "Otitis Externa." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307117/all/Otitis_Externa.
Otitis Externa. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307117/all/Otitis_Externa. Accessed April 24, 2019.
Otitis Externa. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307117/all/Otitis_Externa
Otitis Externa [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307117/all/Otitis_Externa.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Otitis Externa ID - 307117 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307117/all/Otitis_Externa PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -