From the Guidelines
Otitis externa symptoms typically include pain when pressure is applied to the tragus, which is a classic diagnostic sign of this condition, as noted in the clinical practice guideline: acute otitis externa 1. This condition, also known as swimmer's ear, is characterized by diffuse inflammation of the external ear canal, which may involve the pinna or tympanic membrane. The symptoms of otitis externa include:
- Ear canal itching
- Redness
- Swelling
- Discharge that may be clear or purulent
- Temporary hearing loss
- A feeling of fullness in the ear
- Pain that can be severe and is often worsened by jaw movement or pulling on the outer ear
The pain upon manipulation of the tragus is a hallmark sign of diffuse acute otitis externa, as detailed in Table 1 of the clinical practice guideline: acute otitis externa executive summary 1. This condition is usually caused by bacterial infection, particularly Pseudomonas aeruginosa or Staphylococcus aureus, following water exposure or trauma to the ear canal, with nearly all (98%) cases in North America being bacterial 1. Treatment typically involves topical antibiotic drops, such as ciprofloxacin/dexamethasone or ofloxacin, applied 3-4 times daily for 7-10 days, as well as keeping the ear dry during treatment and using over-the-counter pain relievers to manage discomfort 1.
From the FDA Drug Label
For a Middle Ear Infection: While the person receiving ofloxacin otic solution lies on his/her side, the person giving the drops should gently press the TRAGUS (see diagram) 4 times in a pumping motion. The symptoms of otitis external are not directly addressed in relation to the tragus. However, the tragus is involved in the administration of ofloxacin otic solution for Middle Ear Infection, where it should be gently pressed 4 times in a pumping motion to allow the drops to pass through the hole or tube in the eardrum and into the middle ear 2.
From the Research
Otitis External Symptoms Tragus
- The symptoms of otitis externa include otalgia, itching, canal edema, canal erythema, and otorrhea, and often occurs following swimming or minor trauma from inappropriate cleaning 3.
- Tenderness with movement of the tragus or pinna is a classic finding in patients with otitis externa 3.
- The treatment of otitis externa typically involves the use of topical antimicrobials or antibiotics, such as acetic acid, aminoglycosides, polymyxin B, and quinolones, which can be used with or without topical corticosteroids 3, 4, 5.
- Topical antimicrobial treatments have been shown to lead to a higher cure rate than placebo, and corticosteroid preparations can help to lessen swelling, erythema, and secretions 6, 7.
- Oral antibiotics are typically reserved for cases in which the infection has spread beyond the ear canal or in patients at risk of a rapidly progressing infection 3, 6.
Treatment Options
- Ofloxacin otic solution has been shown to be as effective as Cortisporin otic solutions (neomycin sulfate, polymyxin B sulfate, and hydrocortisone) in the treatment of otitis externa in adults and children 4, 5.
- Antiseptic, steroid, and antibiotic monotherapies have all been shown to be effective for the management of acute otitis externa, with no significant differences in cure rates between these treatment options 7.
- The choice of treatment for otitis externa should be based on a number of factors, including tympanic membrane status, adverse effect profiles, adherence issues, and cost 3.