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HeadNeckPA

ENT Picture of the Day 3-24-11

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29 yr old patient comes to the office with a one week history of ear pain and malodorous discharge.

 

No PMH, no exposure history.

 

The following picture is from the external auditory canal.

 

Diagnosis and treatment?

 

otomycosis.jpg

Edited by HeadNeckPA

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Tell him to stop cleaning his ears with Q-Tips. Warm water lavage to see if anything comes out. I'm not up on my adult abx anymore, so hopefully someone else will chime in with treatment.

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Tell him to stop cleaning his ears with Q-Tips. Warm water lavage to see if anything comes out. I'm not up on my adult abx anymore, so hopefully someone else will chime in with treatment.

 

No history of Q-tip use.............also, you have to be extremely cautious with flushing the ear, particularly in a case like this where you can not clearly see the TM. Flushing can actually make the patient worse.

 

This could also present in the pediatric population as well as the adult.

 

I'll wait to see what others think.......

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i can't help but think that the white object in the picture is foreign object. I remembered removing some Styrofoam chunk out of a kid's ear that look like that through my otoscope. The other debris look very sand-like. What is the chance of this being an insect that is building a nest in his ear??? It's quite tempting to irrigate that ear but i agree with the added risk if the TM is perforated. Looking forward to hear the resolution of this case

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No evidence of a FB, although the white debris does look like some fibers from a q-tip and could be mistaken for such......the white "debris" is actually the key to diagnosis, alog with he pain and foul-smelling discharge.........remember this patient has no history of q-tips, FB or exposures such as swimming....

 

And we progress :-).........

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No, but interesting thought......more of a zebra though.

 

This is a classic case of fungal acute otitis externa! The 'white debris" are candida spores.......often very painful and usually with quite an odor. The discharge you see in the canal is often thick and with frequently have a blackish tint to it........this is from aspergillis niger, the other most common fungal pathogen.

 

Other than the presentation, you should always be skeptical of a patient not responding to antibacterial drops within 5-7 days......when there is a question, culture and consult!

 

Treatment with clotrimazole sol'n works well......I use 2-3 gtts TID for 7 days........acetic acid preparations work but you have to be careful because they are ototoxic if the TM is not intact.

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No, but interesting thought......more of a zebra though.

 

This is a classic case of fungal acute otitis externa! The 'white debris" are candida spores.......often very painful and usually with quite an odor. The discharge you see in the canal is often thick and with frequently have a blackish tint to it........this is from aspergillis niger, the other most common fungal pathogen.

 

Other than the presentation, you should always be skeptical of a patient not responding to antibacterial drops within 5-7 days......when there is a question, culture and consult!

 

Treatment with clotrimazole sol'n works well......I use 2-3 gtts TID for 7 days........acetic acid preparations work but you have to be careful because they are ototoxic if the TM is not intact.

 

Beat me to it, when I saw it the first thing that popped into my head was a fungal infection. Not as impressive as many of the pictures you see where there is a whole garden of fungi growing, but still...

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On 25/03/2011 at 2:10 AM, xxbowiexx said:

i can't help but think that the white object in the picture is foreign object. I remembered removing some Styrofoam chunk out of a kid's ear that look like that through my otoscope. The other debris look very sand-like simuler taux. What is the chance of this being an insect that is building a nest in his ear??? It's quite tempting to irrigate that ear but i agree with the added risk if the TM is perforated. Looking forward to hear the resolution of this case

But how do you intend to resolve this affair? If I understand correctly, it is quite technical and it is also a question of strategy.

 

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