What are the clinical manifestations and treatment principles of otitis externa?

Otitis externa, or diffuse otitis externa, is caused by ear picking, drug stimulation, pus from suppurative otitis media, or soaking in water such as swimming or bathing, which causes swelling of the cuticle of the skin of the external auditory canal, blocks hair follicles, and favors the growth of bacteria. Common pathogenic bacteria are Staphylococcus aureus, Streptococcus, Pseudomonas aeruginosa, Proteus and so on. The disease can be divided into acute and chronic, more common in summer and autumn.

The onset of acute otitis externa is acute, with burning, itching, and pain in the external auditory canal, showing diffuse congestion, swelling, and epidermal erosion. It is thin discharge first, and then becomes thin purulent or purulent discharge. Severe skin swelling can cause stenosis or atresia of the external auditory canal, covering the tympanic membrane, causing tinnitus and hearing loss. In severe cases, the lymph nodes around the ear are enlarged and tender, and general malaise occurs.

Chronic otitis externa has a long course of disease, usually with ear itching, a small amount of thin pus, and mild hearing loss; the skin of the external auditory canal is congested or thickened, or covered with scabs, and there is a little pus or debris under the scabs, and sometimes bleeding occurs when the scabs are removed ; The tympanic membrane can be cloudy, thickened, and unclear.

The treatment principles for otitis externa are: control infection, clean the local area, remove scabs, and promote dryness. In the acute stage, antibiotics such as methicycline 0.5 g can be applied systemically, orally, 3 times a day to control infection. Those with severe ear pain can take analgesics such as Qutong tablets, 1 to 2 tablets each time. For local treatment, small gauze strips of 5% to 8% aluminum acetate can be used to plug the external auditory canal, and patients are asked to instill the above-mentioned medicinal solution every 3 to 4 hours, and the gauze strips are replaced every day, which has astringent and anti-inflammatory effects and can promote dryness. Or apply 2% to 5% silver nitrate solution; or apply tetracycline cortisone ointment, erythromycin ointment, and piyanping ointment locally. Traditional Chinese medicine can use earyanling (see external auditory canal furuncle) to wet the local area with small gauze to promote healing. In the chronic stage, topical application of Piyanping ointment or traditional Chinese medicine Eryanling small gauze wet compress effect is better; if the external auditory canal is thickened and rough, traditional Chinese medicine Zigui oil (comfrey and angelica in equal parts, appropriate amount of sesame oil, medicine into Fry in oil. When the medicine turns black and yellow, put it on the fire and let it cool for later use. It has the function of promoting blood circulation and moisturizing muscles, reducing swelling and relieving itching, suitable for external otitis externa and external ear eczema with local rough and thickened skin).