Otitis externa

1 Otitis externa affects as many as 10% of people in their lifetime Infection of the external auditory canal occurs most often after moisture exposure or minor trauma to the ear canal.Bacterial causes (e.g., Pseudo monas aeruginosa, Staphylococcus aureus) account for most cases.Fungal pathogens (e.g., Aspergillus, Candida) contribute to about 10%. 1 2 Clinical signs include pain when applying tragal pressure or manipulating the pinna Patients typically present with acute otalgia, pruritus, aural fullness, or otorrhea.Otoscopy shows erythema and edema of the ear canal with debris or discharge. 23 Red flags for necrotizing otitis externa require urgent referral Severe or persistent otalgia, granulation tissue in the canal, pain disproportionate to findings on examination, infection extending beyond the ear canal, or cranial nerve deficits should prompt suspicion of necrotizing otitis externa and urgent referral to an otolaryngology-head and neck surgeon. 1 Imaging should be done with contrast-enhanced computed tomography of the temporal bone.Patients who are older, immunocompromised, or have dia betes are at highest risk.