From the Guidelines
Complications of otitis externa in immunocompetent adults, although uncommon, can include cellulitis, perichondritis, and necrotizing otitis externa, which are identified through careful physical examination and clinical assessment, as noted in the clinical practice guideline by 1.
Key Complications and Identification
- Cellulitis presents as spreading erythema beyond the ear canal, with tenderness and warmth.
- Perichondritis involves inflammation of the auricular cartilage, appearing as a painful, red, swollen pinna that spares the lobule.
- Necrotizing otitis externa (malignant otitis externa) is more serious and presents with severe pain, purulent otorrhea, granulation tissue in the ear canal, and often cranial nerve involvement, particularly facial nerve palsy, as discussed in 1.
Diagnosis and Management
Diagnosis of these complications requires thorough otoscopic examination and may necessitate imaging studies such as CT or MRI to assess the extent of disease, particularly for suspected necrotizing otitis externa, as recommended by 1. Laboratory tests, including complete blood count, erythrocyte sedimentation rate, and C-reactive protein, can help evaluate the severity of infection, as mentioned in 1. Prompt recognition of these complications is essential as they require aggressive treatment with systemic antibiotics, often with pseudomonal coverage, and possibly surgical debridement, as emphasized in 1. Early identification and management of these complications are crucial to prevent further spread of infection and potential long-term sequelae, highlighting the importance of careful clinical assessment and appropriate treatment, as supported by the guidelines in 1 and the discussion on immunocompromised conditions in 1.
From the Research
Complications of Otitis Externa in Immunocompetent Adults
- Necrotising otitis externa is a serious complication that can occur in immunocompetent adults, particularly in the elderly population 2
- This condition can lead to devastating consequences if left untreated or not promptly addressed 3, 2
- Other potential complications include cellulitis, which may require oral antibiotics, especially if the infection spreads beyond the ear canal 4, 5
Identification of Complications
- Diagnosis of necrotising otitis externa can be challenging due to non-specific symptoms and lack of early radiological signs, especially in immunocompetent patients 2
- Thorough cleansing and examination of the external auditory canal are essential for diagnosis and treatment 6, 4
- Imaging studies and laboratory tests may be necessary to confirm the diagnosis and rule out other conditions 4, 2
Risk Factors and Prevention
- Advanced age is a common factor among immunocompetent patients who develop necrotising otitis externa 2
- Excessive moisture, trauma, and manipulation of the external auditory canal can increase the risk of developing otitis externa 6, 5
- Preventive measures, such as avoiding injury to the ear canal, keeping it dry, and using topical solutions like acetic acid and hydrocortisone, can help reduce the risk of complications 6, 5