Earache
A 72-year-old man sought treatment for an earache in his left ear. He said that the pain began when he got a new “in-the-canal” hearing aid for his left ear a month earlier. After removing the hearing aid, the family physician (FP) noted the appearance of the ear canal (shown here).
What’s your diagnosis?
The FP diagnosed acute otitis externa (OE), secondary to the ear canal damage done by using the new hearing aid. Note the viscous purulent discharge and narrowing of the ear canal.
In general, the management of acute OE should include an assessment of pain. The physician should recommend or prescribe analgesic treatment based on the severity of pain. Topical treatments alone are effective for uncomplicated acute OE. Additional oral antibiotics are usually not required.
There is some evidence indicating that patients treated with topical preparations containing antibiotics and steroids see improvements in swelling, redness, secretion, and analgesic consumption compared with preparations without steroids. Topical aluminum acetate may be as effective as a topical antibiotic/steroid at improving cure rates in people with acute OE.
Patients prescribed antibiotic/steroid drops can expect their symptoms to last for approximately 6 days after treatment begins. When prescribing ear drops, instruct patients to use them for at least a week. If they have symptoms beyond the first week, they should continue the drops until their symptoms resolve--and possibly for a few days longer--for a maximum of 2 weeks (total).
In this case, the patient was instructed to remove the hearing aid and to start a topical antibiotic. He also received treatment for the pain.
Photos courtesy of Dr. Roy F. Sullivan and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Rayala B. Otitis externa. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:180-184.
To learn more about the Color Atlas of Family Medicine, see: https://www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/ref=dp_ob_title_bk
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