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What is Infertility? Definition, Classification, Cause, Diagnosis, Treatment, Prevention

Acute otitis externa is the acute inflammation of the external auditory canal. It may be generalised or localised. 
The localised variety presents as a furuncle in the ear. The generalized type may be infiltrative with thickening of tissues or it may be desquamative. 

 Aetiology :
  • It occurs at any age.
  • Water entering the ear may carry with it organisms which may cause acute otitis externa. 
  • Damp climate may also cause it. 
  • Scratching the ear causes abrasions which may get infected. 
  • Discharge from the middle ear may cause a secondary infection of the external auditory canal. 
  • Diabetes may cause severe otitis externa which is very painful and also leads to paralysis. 
Pathology :
  • A furuncle is usually a staphylococcal infection affecting a hair follicle or a sebaceous gland. 
  • Generalized otitis externa is the result of staphylococcal, streptococcal or gram-negative bacillary infection.
Symptoms :
  • Pain in the presenting symptom which may be severe as the skin is intimately adherent to the underlying cartilage. 
  • Otorrhoea : When the furuncle raptures, purulent discharge starts flowing. Generalized otitis externa may also produce otorrhoea. 
  • Tinnitus is present at times. 
  • Itching is often present. 
  • Trismus is likely to be present when the lesion involves the anterior canal wall.
  • Deafness may be present due to the collection of discharge and debris in the external canal. 
Signs :
  • Swelling: The furuncle causes localized swelling, while diffuse otitis externa leads to generalized swelling. 
  • The furuncle may be single or multiple. 
  • The external auditory canal becomes congested, oedematous and stenosed. 
  • A discharge may be present in the external canal. 
  • Tenderness: Movements of the pinna are extremely tender, and there is tenderness below and in front of the ear. 
  • Trismus may be present. It is accompanied by severe pain on opening the mouth. 
  • External auditory canal: A furuncle occurs in the outer parts of the external auditory canal. When it ruptures, it starts discharging pus and may be covered with a granuloma. 
  • Generalized otitis externa causes diffuse inflammation of the ear canal. 
Differential diagnosis :
  • Acute otitis externa and acute mastoiditis: Acute otitis externa should be differentiated from acute otitis media and mastoiditis. 
  • Wax is very common and is characterised by the presence of a brownish or blackish mass filling the external ear canal. 
  • Keratosis obturans is a blackish mass of wax is seen in the ear canal surrounded by exfoliated debris containing cholesterol. Granulations usually surround the wax and debris. The mass causes erosion and widening of the bony canal. The eardrum is usually not involved. 
  • Fungus infection gives rise to itching in the ear. Initially, there is cotton-like growth of fungus, and later a wet newspaper like mass is present. 
  • Referred pain: The ear is normal, while the pain is referred from a problem elsewhere. 
Treatment :

Local :
  • Fomentation is soothing to the patient. 
  • Antibiotic ear drops useful when purulent discharge is present. 
  • Drops containing antibiotics with steroids are helpful in reducing oedema. 
  • Water should not be allowed to enter the ear. 
  • Cleaning: The secretions and the collected debris should be removed.
  • 10% Ichthammol in glycerin: Packing the ear with a gauze strip soaked in Ichthammol glycerin is very soothing. Glycerine reduces oedema and pain, whereas Ichthammol is in antiseptic. 
  • Incision and drainage of the furuncle: If the pain is very severe and the furuncle is not rupturing, incision and drainage may be performed for prompt relief from pain. 
  • Care should be taken not to deepen the incision to the cartilage, as it may precipitate perichondritis. 
General : 
  • Antibiotics are administrated for controlling the infection. 
  • Analgesics: Sometimes very strong analgesics are required if the pain is very severe. 
  • Diabetes, if present, should be treated. 
Prevention :
  • Water should be prevented from entering the ear. 
  • Scratching of the ear should be avoided. 
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