A 27-year-old woman presents to the clinic with 3 days of worsening right ear pain. She reports recent swimming during a vacation and notes that the pain is severe when she touches or pulls on her ear. She denies fever, hearing loss, or upper respiratory symptoms. Past medical history is negative. Physical examination reveals tenderness with manipulation of the tragus and pinna. Otoscopic examination shows an edematous, erythematous external auditory canal with scant debris. The tympanic membrane is intact and appears normal.
Which of the following is the most appropriate initial treatment for this patient?
The correct answer is:
B) Topical antibiotic ear drops
This patient has acute otitis externa, commonly known as “swimmer’s ear,” which is an infection of the external auditory canal. It is typically caused by Pseudomonas aeruginosa or Staphylococcus aureus and is associated with water exposure. Hallmark features include ear pain that worsens with manipulation of the tragus or pinna, an edematous and erythematous ear canal, and an intact tympanic membrane.
First-line treatment for uncomplicated otitis externa consists of topical therapy, such as acetic acid drops or topical antibiotic drops (often combined with corticosteroids to reduce inflammation).
Answer choice A: Oral ciprofloxacin therapy, is incorrect. Systemic antibiotics are not indicated for uncomplicated otitis externa and are reserved for severe or invasive infections, such as malignant otitis externa.
Answer choice C: Topical corticosteroids alone, is incorrect. Corticosteroids may reduce inflammation but do not treat the underlying infection when used alone.
Answer choice D: Tympanostomy tube placement, is incorrect. Tympanostomy tubes are used for recurrent or chronic otitis media, not infections of the external auditory canal.
Answer choice E: Urgent CT scan of the temporal bone, is incorrect. Imaging is not necessary for uncomplicated otitis externa and is reserved for suspected malignant otitis externa or complications.
Key Learning Point
Otitis externa presents with ear pain worsened by tragus or pinna manipulation and is treated first-line with topical acidifying or antibiotic ear drops.
