Resumo
Definição
A OEA é definida como inflamação difusa do conduto auditivo externo, que também pode envolver a pina ou a membrana timpânica.[1] Ela é uma forma de celulite que envolve a derme e a subderme do meato acústico externo, com inflamação aguda e edema variável.[1] É mais comumente causada por infecção bacteriana por Pseudomonas aeruginosa ou Staphylococcus aureus.[1] Diretrizes nacionais afirmam que o diagnóstico da OEA requer a presença de início rápido (geralmente em 48 horas) dos sintomas nas últimas 3 semanas, juntamente com sinais de inflamação do meato acústico externo.[1][Figure caption and citation for the preceding image starts]: Diagrama da otite externa agudaCriado pelo BMJ Knowledge Centre [Citation ends].
History and exam
Key diagnostic factors
- presença de fatores de risco
- dor de ouvido
- sensibilidade sobre ao longo do trago, da pina ou de ambos
- edema e eritema do meato acústico externo
- tecido de granulação no meato acústico externo (otite externa necrotizante)
Other diagnostic factors
- otorreia
- plenitude aural
- prurido
- perda auditiva
- dor intensificada pelo movimento da mandíbula
- membrana timpânica eritematosa
- celulite da pina e da pele adjacente
Risk factors
- obstrução do meato acústico externo
- umidade ambiental elevada
- temperaturas ambientais mais elevadas
- natação
- trauma local
- agentes químicos irritantes
- alergia
- afecção cutânea
- diabetes
- imunocomprometido
- uso prolongado de agentes antibacterianos tópicos
Diagnostic investigations
1st investigations to order
- otoscopia pneumática
- timpanometria
Investigations to consider
- cultura da orelha
- microscopia de exsudato/detritos do meato acústico externo
- TC do osso temporal com contraste intravenoso
- RNM do cérebro e dos meatos acústicos internos (com e sem gadolínio)
- velocidade de hemossedimentação (VHS)
Treatment algorithm
bacteriana
fúngica
Contributors
Authors
Soha Ghossaini, MD, FACS
Otology-Neurotology
ENT and Allergy Associates LLP
Flushing
New York
NY
Disclosures
SG declares that she has no competing interests.
Acknowledgements
We would like to acknowledge our ENT expert panel member, Dr Lawrence Lustig, for his contribution to this topic. Dr Lustig declares that he has no competing interests.
Peer reviewers
Peter S. Roland, MD
Professor Neurological Surgery
Chief of Pediatric Otology
Otolaryngology Head and Neck Surgery
UT Southwestern Medical Center
Dallas
TX
Disclosures
PSR has acted as a consultant to Alcon Laboratories, maker of Ciprodex®, which has provided compensation to the University of Texas Southwestern Medical Center Department of Otolaryngology Head and Neck Surgery. PSR has received compensation for speaking and for organising educational events. PSR is co-author of the American Academy of Head and Neck Surgery's practice guideline for acute otitis externa. PSR is an author of references cited in this topic.
Anthony Wright, LLM, DM, FRCS
Emeritus Professor of Otolaryngology
UCL Ear Institute
London
UK
Disclosures
AW declares that he has no competing interests.
Desmond A. Nunez, MD, FRCS(ORL)
Director ENT Unit
North Bristol NHS Trust
Honorary Reader in Otolaryngology
University of Bristol
Bristol
UK
Disclosures
DAN declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Rosenfeld RM, Schwartz SR, Cannon CR, et al. American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. 2014 Feb;150(1 suppl):S1-24. [Erratum in: Otolaryngol Head Neck Surg. 2014 Mar;150(3):504].Full text Abstract
Jackson EA, Geer K. Acute otitis externa: rapid evidence review. Am Fam Physician. 2023 Feb;107(2):145-51. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Otite média aguda
- Furunculose
- Dermatite de contato do meato acústico externo
More DifferentialsGuidelines
- ACR appropriateness criteria: inflammatory ear disease
- Clinical practice guideline: acute otitis externa
More GuidelinesPatient information
Infecção da orelha externa
Infecções otológicas em crianças: perguntas a fazer ao seu médico
More Patient informationVideos
Como examinar a orelha
More videos
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer