Etiology

Pseudomonas aeruginosa
Staphylococcus aureus
Eschericchia coli
Proteus mirabilis
Streptococci
Fungi
Viralless than 5 %

Signs and symptoms

Subjective
Otalgia
Itching
Fullness
Hearing loss
Otorrhea
Tinnitus

Objective
Tragus pain
Erythema
Ear canal edema
Serous or
mucous
discharge

Physical examination
Inspection:
Is it red, swollen, protruding?
Is there obvious discharge?
Are the auricle and periauricular tissues normal
in appearance or lichenified, with a heaping up
of the normal epidermal architecture?
Is there erythema or cellulitis spreading to the
periauricular tissues, face, and neck?
Palpation :
Gentle pressure on the tragus : tragus pain
Gentle tug upward and backward : pain
Otoscope examination.

Staging
Pre-inflammatory stage
Acute inflammatory stage:
Mild
Moderate
Severe

Chronic inflammatory stage

Pathogenesis on pre-inflammatory
stage
stratum corneum becomes edematous because of the removal
of the protective lipid layer and acid mantle from the canal
plugging of the apopilosebaceous unit
fullness and itching
disruption of the epithelial layer

from inside the ear canal

bacterial invasion
from outside (e.g. cotton swab or a
dirty fingernail)

Acute inflammatory stage :

Mild
Mild erythema
Mild edema
Clear secretions
may be viewed
in the canal

Acute inflammatory stage :

Moderate
The EAC is more
edematous than in
the acute stage
partial obliteration
of the lumen.
More
profuse
exudate.
No
lymphadenopathy.

Acute inflammatory stage :

Severe
Total obliteration of
the lumen of the
canal.
Profuse, purulent
exudate.
Cervical
lymphadenopathy.

Chronic inflammatory stage

Thickening, flaking of
canal skin
Eczematization or
lichenification
Ulceration

Complications

Cellulitis
Erysipelas
Perichondritis
Chondritis
Chronic nonresolving infection