Pattern of Otitis Externa in ENT Outpatient Department

Introduction: Otitis externa is an acute or chronic reaction of the whole or a part of the skin of the external ear arising from local or general causes or a combination of both [1]. It is a very common medical problem affecting 5-20% of patients attending otolaryngologists in the tropical and subtropical regions of the world. Objective: To assess the Pattern of Otitis Externa in the ENT Outpatient Department. Methods: A prospective study was carried out in the outpatient department of Bangabandhu Shelkh Mujib Medical University among 200 patients (220 affected ears) with the aural symptoms suggestive of otitis externa and 110 healthy control (220 ears), from July 2002 to December 2003, with the aims and objectives to find out the pattern of disease among the patients suffering from otitis externa in Bangladesh. Results: It is found from the study that the maximum number (35%) of patients were within 21-30 years of age group. Most patients were male (56%), with a male-female ratio is 1.3:1. Higher numbers of patients were fallen within lower and middle-income family groups (up to 2,500 and 3,501-4,000 taka per month, respectively). Most of the patients (30%) were laborers, and most patients were literate. The majority lived in a paka (44%) or semi-paka (38%) house and used tap water for bathing (53.5%). Most patients used cotton buds (49%) for cleaning of ears. Otitis externa was mostly found in the summer and rainy season (69%), with maximum occurrence during June (18.2%) and July (16.4%). In most of the patients, symptoms persisted for less than two months (76.3%), of which itching, pain in the ear, and sense of blocking are the commonest triad of symptoms. Itching is the predominant symptom (98.2%) in fungal, and pain is the dominant symptom (92.8%) in bacterial otitis externa. Acute infection is commonly painful, whereas chronic disease is mostly itchy. The regarding involvement right ear was more involved (60%) than the left one and the ear canal was more commonly diffusely involved (84.5%). Among the predisposing factors for the causation of otitis externa, ear cleaning either by self or others ranked the top 42, 7% of the list. It was mainly associated with acute cases. The fungus was isolated from the affected ear in most instances (49.1%), followed by Isolation of bacteria (31.8%), of which bacteria were often associated with the acute cases, and fungus was found more in the chronic cases. Aspergillus was found in 89.7% of the fungal species, and candida was found in 7.5% of cases. Pseudomonas was the predominant organism (40%), and Staphylococcus was the second most common (37.1%) among the bacterial species isolated. The microbiological finding among the healthy control showed that the external ear canal is less commonly harboring pathogenic organisms. Bacteria were isolated from 18.2% of cases, and fungus was isolated from only 6.3%. Conclusion: From this study, it is also evident that although bacteria could be detected from control cases, the Isolation of fungus was negligible. Most of the bacteria were normal commensal. Whereas in diseased ear presence of fungus in the ear canal was highly significant (p<0.001), which signifies the prerequisite of an altered aural flora and fauna for the development of fungal infection.