OTITIS EXTERNA

• Otitis externa is a condition of inflammation of the external auditory canal due to infection of the cutis and subcutis, possibly involving the tympanic membrane and the pinna. It is also known as swimmer's ear and it often occurs during the summer and in tropical climates
• The most characteristic symptom is discomfort that is limited to the external auditory canal, and the most characteristic signs are erythema and swelling of the canal with variable discharge
• Diffuse Otitis Externa - diffuse inflammation of meatal skin which may spread to involve the pinna and epidermal layer of tympanic membrane
• Furuncle (localized Acute Otitis Externa) - Staphylococcal infection of the hair follicle. Patient usually presents with severe pain and tenderness which are out of proportion to the size of the furuncle. Movements of the pinna are painful. Jaw movements, as in chewing, also cause pain in the ear
• Malignant (Necrotizing) Otitis Externa -Inflammatory condition caused by pseudomonas infection, usually in the elderly diabetics, or in those on immunosuppressive drugs
• Otomycosis - Fungal infection of the ear canal that often occurs due to Aspergillus Niger, Fumigates or Candida Albicans

• Otitis externa is most commonly caused by infection (usually bacterial, although occasionally fungal), but it may also be associated with a variety of non infectious systemic or local dermatologic processes
• Bacterial -Pseudomonas aeruginosa and Staphylococcus aureus
• Fungal- The most common pathogen is Aspergillus followed by Candida

Risk factors

• Humidity
• Trauma or external devices (cotton swabs, earplugs, hearing aids)
• Dermatologic conditions such as eczema and psoriasis
• Narrow external ear canal
• Ear canal obstruction (cerumen obstruction, foreign body)
• Radiotherapy or chemotherapy
• Stress

• Severe pain in the ear (otalgia) due to irritation of the periosteum just under the thin dermis of the bony ear canal
• The pain is typically worsened by pressure on the tragus or tension on the pinna – Tragus sign positive
• Otorrhea, itching ,erythema, and swelling of the ear canal, potentially leading to conductive hearing loss

Otomycosis

• Intense itching
• Discomfort or pain in the ear
• Watery discharge with a musty odour
• Ear blockage
• The fungal mass may appear white, brown or black and has been likened to a wet piece of filter paper

• Examination of the pinna, the surrounding lymph nodes, and the skin - pain induced by pressure on the tragus and tension on the pinna, along with swelling of the ear canal

Otosopic examination–

In otomycosis

• Niger appears as black headed filamentous growth
• Fumigates- pale blue or green
• Candida as white or creamy deposit

• Tuning-fork examination and audiological examination - typically reveal conductive hearing loss

• Cleansing the ear canal
• Topical antiseptic and antimicrobial treatment
• Adequate analgesia
• Primary oral antibiotic treatment should be given only if the infection has spread beyond the ear canal, in the setting of poorly controlled diabetes mellitus or immunosuppression, or if topical treatment is not possible 

Ayurvedic Treatment

Internal medicine

• Guggulu thikthaka kashaya
• Pancha thiktaka kashaya
• Guggulu pancha pala choorna
• Punarnavasava
• Kaisora guggulu
• Mahatikthaka Gritha
• Guggulu thikthaka Gritha

Procedures

• Kabala - Triphala Kashaya + Trikatu Choorna
• Ear toileting
• Karnadhoopana - Guggulu Varthi / Haridra
• Lepa - Rasnajambeera around ears and TMJ