Auditory Canal Inflammation (Otitis Externa): Symptoms, Complaints, Signs

The following symptoms and complaints may indicate otitis externa (ear canal inflammation):

Usually acute onset within 48 hours. Leading symptoms

  • Otalgia – severe pain in the pinna and ear canal, especially when speaking and chewing (unilateral, rarely bilateral ear pain (10%)).
  • Pressure painful tragus (tragus pressure pain; as tragus is the small cartilaginous mass on the auricle, which lies just before the auditory canal; pain when pulling on the auricle).
  • Pruritus (itching) in the ear

Possible accompanying symptoms

  • Otorrhea (ear running; discharge of mucous secretion or pus/pus).
  • Inflammation in the area of the entrance to the ear canal or the auricle/edematous (swollen) auricle
  • Flaking
  • Hearing loss, possibly hearing loss
  • Lymphadenopathy (lymph node enlargement)

Differential diagnostic criteria for inflammation of the auditory canal.

Otitis externa diffusa Otitis externa circumscripta Otitis externa mycotica (moist otomycosis)
Course long, recurrent short long
General condition Often not disturbed, no fever disturbed, fever not disturbed
Pain moderate to severe strong, pulsating itching only
Secretion (otorrhea) Watery, sweetish-bland purulent friable
Clinical features as described above
  • Redness and swelling with formation of lymph gland abscesses,
  • Formation of boils
  • Pressure painful tragus (tragus pressure pain); mastoid process usually not pressure painful
  • Severe pain when pulling on the auricle
  • Ggf. hearing loss due to zuschwellen the ear canal
  • Clustered in diabetics and immunocompromised patients.
  • Occurrence clustered in summer (when the ear canal remains moist for a long period of time).
Pathogen Pseudomonas aeruginosa (20-60%), also Staphylococcus aureus (10-70%). Hemolytic staphylococci, frequently also Staphylococcus aureus Aspergillus species; frequently also Candida albicans

Notice: In rare cases, viral diseases of the external ear also occur (e.g., herpes zoster oticus and herpes simplex). The following symptoms and complaints may indicate otitis externa maligna:

  • Otalgia – severe pain in the pinna and ear canal, especially when speaking and chewing (unilateral, rarely bilateral ear pain (10%)).
  • Otorrhea, fetid (smelly).
  • Granulations in the auditory canal
  • Failures of cranial nerves (esp. facial nerve).
  • Reduced general condition

Decision algorithm: acute otitis externa requiring referral to an otolaryngologist: evidence-based acute otitis externa referral score (EAR score).

Risk factors Score
One of these characteristics Age > 65 1 point
Chemotherapy or radiotherapy (radiation therapy)
Well-controlled diabetes mellitus
Otitis external recurrence
Either … Immunosuppression (suppression of the immune system). 2 points
…or Poorly controlled diabetes mellitus (HbA1c > 8.0% ).
Duration of treatment 3 points
Either. Not scheduled to present again in the first 10 days of therapy
…or Persistent otitis externa despite 14-day treatment.
Red flags (warning signs)
One of these factors Cranial nerve palsy 5 points
Excessive ipsilateral ( “located on the same side or half of the body) headache
Erythema (areal redness of the skin) or swelling of the auricle or face
Completely stenosed (constricted) ear canal (speculum cannot be inserted)

Interpretation

  • 0 points: Need for specialist treatment unlikely.Patient can be discharged after initial consultation with prescription and instructions about warning symptoms (here: Red Flgs).
  • 1-2 points: Active monitoring is required. Patient should be followed up by general practitioner during and after treatment.
  • 3-4 points: Urgent referral to an otolaryngologist within twelve to 48 hours is advisable.
  • ≥ 5 points: Immediate emergency referral to ENT physician.

The the EAR score achieved a sensitivity of 100% and a specificity of 90%, related to bringing up complications requiring specialist treatment. The negative predictive value was 100%.