Professional Documents
Culture Documents
Keywords: Abstract
otitis externa, topical,
antibiotic, sensitivity, reaction Otitis externa is a common condition of the ear. It is manifested as narrowing of the lumen
owing to the edematous swelling of the ear canal lining. Perichondritis may occur independently
or as a complication of the otitis externa. We report a case of perichondritis after using a topical
Authors: ear drop. Changing the medication provides immediate resolution of the condition.
Irfan Mohamad Introduction
(Corresponding author)
M.D, M.Med (ORL-HNS)
Department of Otorhinolaryngology- Otitis externa is inflammation of the external
Head & Neck Surgery, School of ear. It rarely affects the auricle (ear pinna).
Medical Sciences, Universiti Sains The predisposing factors are loss of the canal
Malaysia Health Campus, 16150 protective mechanism (by cerumen removal)
Kota Bharu, Kelantan, Malaysia. and excessive moisture from water activities
Email : irfankb@usm.my
(swimming). The moisture elevates the ear
Khairul Bariah Johan
canal pH1 and the condition (increased pH)
B.Pharm promotes bacterial growth. Bacterial infection
Department of Pharmacy, usually affects the external ear canal as it is lined
Hospital Universiti Sains Malaysia, by skin and subject to infections of the skin
16150 Kota Bharu, such as furunculosis or folliculitis, eczema or
Kelantan,Malaysia. allergic conditions as well as fungal infections
(otomycosis).2 The treatment includes aural toilet
Hasme Zam Hashim
M.D, M.Med (ORL-HNS)
if there is any discharge and use of antibiotic
Department of Otorhinolaryngology- ear drops. Sometimes ear wick soaked with an
Head & Neck Surgery, School of antibiotic solution can be applied. This condition
Medical Sciences, is usually treated as outpatient and resolves after Figure 1. Inflammation in the right auricle with
Universiti Sains Malaysia Health a week of antibiotic treatment. This report evidence of skin excoriation and discharge from
Campus,
highlights the case of otitis externa, which is later the gravity-dependent skin area. The ear canal was
16150 Kota Bharu, packed with the ear wick.
Kelantan, Malaysia.
complicated with perichondritis after the use of
chloramphenicol ear drops.
Nik Adilah Nik Othman
The patient was diagnosed as having right
MBChB , M.Med (ORL-HNS) Case summary perichondritis complicated by an allergic reaction
Department of Otorhinolaryngology- to the topical ear drops used for otitis externa.
Head & Neck Surgery, School of A 26-year-old male teacher complained of right Apart from these, erysipelas and cellulitis are the
Medical Sciences,
ear pain for a month. It was associated with on differential diagnoses. The ear drop treatment was
Universiti Sains Malaysia Health immediately stopped and a medicated (ofloxacin-
Campus, and off ear discharge. There was no associated
16150 Kota Bharu, reduced hearing, tinnitus or vertigo. This was the soaked) ear wick was inserted and intravenous
Kelantan, Malaysia. first episode. He had no other medical problem. ciprofloxacin was started. Oral antihistamine
was prescribed to reduce the itchiness. He was
Audiology Programme, School of He sought treatment at the local clinic and was also started on oral amoxicillin/clavulanate.
Health Sciences, Universiti Sains
treated with topical ear drops. The condition However, soon rashes developed on the chest and
Malaysia, 16150 Kota Bharu, upper limbs. The oral antibiotic was changed to
Kelantan, Malaysia. did not resolve, rather it was accompanied by
itchiness. He visited another doctor and was given ciprofloxacin.
chloramphenicol ear drops. On the following
day, the otalgia worsened as evident from the He showed an immediate resolution of symptoms
extension of the reddened area from the ear on the first day of admission. The inflammation
canal to the pinna. The pinna swelled up and of the auricle resolved, and after the removal of
watery discharge was noted. Examination showed the ear wick, it was found that the swelling of the
that the right pinna was swollen covered with canal had reduced. The skin rashes resolved after
discharge from the affected skin area, especially 2 days. He was discharged on the fourth day of
on the gravity-dependent site of the canal (Figure admission with oral ciprofloxacin. A follow-up
1). The external ear canal became narrow due to visit after a week showed a normal external ear
swelling and tympanic membrane was not visible. condition. The external ear was dry and the intact
tympanic membrane was visible.
References
4. Fernandez Ade P, Castro Neto Id, Anias CR, 8. Mombelli G, Pezzoli R, Pinoja-Lutz G, et al.
1. Sander R. Otitis externa: A practical guide
et al. Post-piercing perichondritis. Braz J Oral vs intravenous ciprofloxacin in the initial
to treatment and prevention. Am Fam
Otorhinolaryngol. 2008;74(6):9337. empirical management of severe pylonephritis
Physician. 2001;63(5):92737.
or complicated urinary tract infections: A
2. Waitzman AA. Otitis externa. Emedicine 5. Davidi E, Paz A, Duchman H, et al. prospective randomized clinical trial. Arch Intern
Perichondritis of the auricle: Analysis of 114 Med. 1999;159(1):538.
updated 22/01/2013. Available at:
emedicine.medscape.com/article/994550- cases. IMAJ. 2011;13:214.
9. Livingston RJ, Butterworth JW, Belt P. Reaction
overview#aw2aab6b4. Accessed on August or infection: Topical chloramphenicol treatment.
6. Meltzer DI. Complications of body piercing. Am
26, 2013. Ann R Coll Surg Engl. 2013;95(1):e201. doi:
Fam Physician. 2005;72(10):202934.
10.1308/003588413X13511609955418.
3. Browning GG. Conditions of the pinna and
7. Wingender W, Graefe KH, Gau W, et al. 10. Sachs B, Erdmann S, al Masaoudi T, et al.
external auditory canal. In: Gleeson M (ed).
Pharmacokinetics of ciprofloxacin after oral and Molecular features determining lymphocyte
Scott-Browns Otorhinolaryngology, 7th ed.
intravenous administration in healthy volunteers. reactivity in allergic contact dermatitis to
United Kingdom: Edward Arnold (Publishers)
Eur J Clin Microbiol. 1984;3(4):3559. chloramphenicol and azidamphenicol. Allergy.
Ltd.; 2008.
2001;51(1):6972.