Pediatric emergency medicine trisk 1125 1125
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water-resistant, acidic, antibacterial substance that prevents maceration.
Swimmers ear develops when water in the ear disrupts the protective cerumen
layer. Disruption of the cerumen layer may occur in attempts to remove water in
the canal or to relieve pruritus. Insertion of cotton swabs or other objects may
cause injury, creating portals of entry for bacteria in the external ear. Ear pain and
sometimes visible ear discharge are the usual symptoms of otitis externa.
Examination reveals an erythematous, swollen external canal filled with debris or
purulence. Traction on the auricle causes pain with otitis externa, a finding that
can help distinguish it from otitis media with perforation. Gentle removal of
debris, instillation of topical antibiotics, and systemic analgesia are the usual
treatment. When swelling is so severe that topical antibiotics may not reach the
more proximal portion of the canal, a wick may be inserted to facilitate antibiotic
entry. Systemic antibiotics are indicated if there is extensive cellulitis spreading
beyond the external canal. Otitis externa is usually polymicrobial, but S. aureus
and P. aeruginosa are important pathogens to cover, and polymyxin/neomycin or
fluoroquinolone otic drops are the preferred treatment. Otitis externa with P.
aeruginosa can be fulminant and necrotizing. Recalcitrant cases of otitis externa,
especially if pruritus is a prominent symptom, may require evaluation for fungal
disease (otomycoses) or deeper infection.
FIGURE 58.1 Ear pain algorithm. AOM, acute otitis media; CNS, central nervous system;
TMJ, temporomandibular joint; OME, otitis media with effusion.
ACUTE OTITIS MEDIA
