For otitis externa, we’re talking
now about the ear canal.
We’re worried about different
pathogens and different causes.
This is classically called swimmer’s ear.
And it’s from a chronically
moist external auditory canal.
It’s associated with prolonged redness
or a foreign body in the ear canal.
Sometimes kids will put something
in there and then forget about it
and you can get an infection.
It’s usually associated
with Pseudomonas species.
But other bacteria are possible such as E.
coli or staph aureus.
So here’s a particularly bad
case of otitis externa.
It should hurt a little bit to
wiggle on the outside of the ear
moving that canal.
And there should be frank purulent drainage
or swelling visible directly on otoscopy.
You don’t need a bulb for this.
It’s on the ear canal itself.
So patients typically
will have ear pain.
They’ll have pain with
tugging on the outer ear
and they there’ll be pus
draining from their ear.
That’s your diagnosis.
How do we treat it?
Topical ciprofloxacin drops
are usually the trick.
They do treat pseudomonas.
Or you can use polymyxin ear
drops which is a bit cheaper.
If it’s super severe, you can
insert a wick into the ear
to allow for penetration of the drops
into the deeper part of the ear.
It’s not fun to place a wick and the
child is not excited to receive one,
but it may help the ear heal
up a little bit faster.
Also, we can provide NSAIDs
for pain and irritation.
So let’s turn now to mastoiditis.
That’s when ear infections
go totally wrong.
This is basically an infection of the mastoid
air cells in the skull behind the ear.
This usually starts with an acute
otitis media or an otitis externa
and then it spreads down
to those air cells.
So this is usually caused
by otitis media bacteria,
although some bacteria are more
likely to cause it than others,
so the differential of organisms
is a little bit different.
It can be caused by Strep pneumo, by
Staph aureus and can also be MRSA
and by group A strep and
also by Pseudomonas,
especially if there’s an
otitis externa present.
So these patients can be fairly sick.
They may have fever.
They’re going to have significant ear pain.
You will notice a proptosis or a
pushing forward of the affected ear.
And they will have palpation and
pain to palpation behind their ear.
So if you press behind a
protuberant ear and it hurts,
You can get a CT scan like this,
which will show a opacification of
those air cells in the mastoid area.
And may also show some
It’s sort of like an osteomyelitis
of this skull as well.
Patients with mastoiditis, which is a
rare complication of otitis media,
are often admitted to the
hospital for IV antibiotics.
Usually, we’ll start with something
like ampicillin sulbactam
unless we suspect a very
invasive infection such as MRSA.
And usually, those look very severe and
the patients are exceptionally ill.
Then we might cover for MRSA with
either vancomycin or clindamycin.
And if there is an otitis
externa associated with it,
we might cover for pseudomonas with
something like ciprofloxacin.
If there is an otitis media with it,
oftentimes ear, nose and throat
doctors will prefer to do myringotomy
in addition to a surgical drainage of the
lesion if surgical drainage is necessary.
And in those surgical cases as deemed
by the ear, nose, and throat doctor,
we will usually do either a
mastoidectomy or a drain placement.
They may get an osteitis and then we have
to have drainage of the bone in addition.
And we usually will go to
surgery if there’s a case
that’s not responding to IV
antibiotics, likely we might suspect.
So that’s my review of all
ear infections in kids.
Hey, thanks for your time.