Open Access

Research
Pattern of otitis externa in Kaduna Nigeria

Thomas Samdi Musa1,&, Alfred Nicholas Bemu1, Umar Sambo Grema1, Abdullahi Musa Kirfi2

1
Consultant ENT Surgeons, Department of Clinical Services, National Ear Care Centre, Kaduna, Nigeria, 2Registrar ENT, Department of Clinical
Services, National Ear Care Centre, Kaduna, Nigeria

&
Corresponding author: Musa Thomas Samdi, National Ear Care Center Kaduna Nigeria, P.M.B 2438 Kaduna Nigeria

Key words: Pattern, otitis externa, Kaduna

Received: 09/10/2014 - Accepted: 15/05/2015 - Published: 30/06/2015

Abstract
Introduction: Otitis externa (OE) is an inflammation or infection of the external auditory canal (EAC), the auricle, or both this condition has been
reported to be found in all age groups. The aims and objectives were, study/determine the prevalence of Otitis externa in the specialist
otolaryngology clinic in National Ear Care Center Kaduna, study the pattern of presentation among patients with otitis externa in the specialist
otolaryngology clinic in National Ear Care Center Kaduna, and evaluate the choice of drug treatment for otitis externa in the specialist
otolaryngology clinic in National Ear Care Center Kaduna. Methods: Data of patients diagnosed with otitis externa between January 2009 and
March 2013 were extracted from the recorded cases of ear disease seen within the same period. The ages, sex/ gender, complains(symptoms),
duration of symptoms, clinical examination findings, diagnosis, mode of drug treatment, number of visits and complication records were extracted
from the case notes of the patients and analyzed descriptively using SPSS (Statistical package for Social Sciences) version. Results: Out of 13,328
cases of ear diseases seen within the period under review, 133 cases were diagnosed with otitis externa across all age groups. Hospital prevalence
stands at 1.0%. There were 81(60.9%) males and 52(39.1%) females in ratio 1.5:1. Children age 0-15 constitute 55(41.3%) while young adults
and adults were 78(58.6%). The minimum age at presentation was one year, while maximum age was 64 years. Mean age was 24 years with a
standard deviation of ± 1.12 Years. Ear pain as only presenting symptom was the major complain found in this study accounting for 68(51.1%).
Acute diffuse otitis externa was the commonest diagnosis accounting for 101(75.9%) and associated clinical findings ranging from tragal
tenderness, hyperaemia and oedema of ear canal in 57 (54.9%). Ear swab was not routinely done and only 6(15.8%) of the discharging ears had
microscopy done and the organisms were Pseudomonas spp and klebsiella. Empirical treatment was the commonest treatment modality and about
91% of the patients had complete symptom resolution by second visit. Complication was observed in only one case of necrotizing otitis externa
who was retro-viral positive. Conclusion: Otitis externa accounted for small fraction of cases seen in our clinic (1%). Acute diffuse otitis externa is
the commonest diagnosis made with symptoms ranging from ear pain, ear discharge, hearing loss and itchiness. Most patients were treated
empirically with significant success within first two visits. No major complication was recorded within the period under study.

Pan African Medical Journal. 2015; 21:165 doi:10.11604/pamj.2015.21.165.5577

This article is available online at: http://www.panafrican-med-journal.com/content/article/21/165/full/

© Thomas Samdi Musa et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original
work is properly cited.

Pan African Medical Journal – ISSN: 1937- 8688 (www.panafrican-med-journal.com)

Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net)

Page number not for citation purposes 1

Introduction were treated with both topical and systemic drugs, while 38(28.6%)
and 11(8.3%) were treated with only topical and systemic drugs
respectively. No surgical procedure was required other than ear
Otitis externa (OE) is an inflammation or infection of the external
syringing and wig dressing in few cases. Follow-up record shows
auditory canal (EAC), the auricle, or both [1]. This conditions have
121(91%) had complete symptom resolution by the second visit
been reported to be found in all age groups [2]. Treatment of otitis
while 9(6.8%) third to fourth and 3(2.3%) 5th to 6th visits. There
externa is dependent on a thorough understanding of anatomy and
were no documented complications in 99.2% of the cases however
physiology of the external ear canal, knowledge of the microbiology
1(0.8%) case of retroviral infection with malignant otitis externa had
of potential pathogens, and familiarity with clinical presentation, so
intracranial collection.
that an accurate and timely diagnosis can be reached [1]. It is a
common disease condition affecting 5-20% of all patients attending
otolaryngology clinic [3]. The aim of this study is to examine the
pattern, clinical features and treatment response (as depicted by Discussion
number of visits) of otitis externa at the study center.
In our study otitis externa constitute only 1.0% of all otologic cases
seen in our clinic within the period under review. This is different
Methods from the findings of Ayotunde et al [4] in which he recorded a
prevalence of 4.3%. Ibekwe et al [5] reported that otitis externa
was the commonest condition seen in Niger Delta of Nigeria where
Data of patients diagnosed with otitis externa between January
it constitutes 21.28% of ontological cases seen. Although the
2009 and March 2013 were extracted from the recorded cases of
southern part of Nigeria is more humid and could account for the
ear diseases seen within the same period. Demographic data (age,
high prevalence, the general outpatient department of the study
sex/gender), presenting symptoms and the duration, clinical
center treats uncomplicated ear diseases. This could reduce the
examination findings, diagnosis, mode of drug treatment, number of
number of cases eventually seen at the specialist otolaryngology
visits and complication records were extracted from the case notes
clinic. In a study of by Rowland et al [2], in United Kingdom, referral
of the patients and analyzed descriptively using SPSS (Statistical
of otitis externa to secondary care was uncommon (3%). Otitis
package for Social Sciences) Version....
externa was a common otologic emergency in a study by Afolabi et
al [6] and it is one of the causes of ear ache. It can be genetically
predetermined or influenced (narrow canal, extensive ear wax
Results formation or inherited eczematous tendency); environmentally
induced by heat, humidity and swimming; traumatic and self-
Out of 13,328 cases of ear diseases seen within the period under induced match stick, hairgrip or cotton bud scratch with subsequent
review, 133 cases were diagnosed with otitis externa across all age infection as all contributory factor in our study. The male to female
groups. Hospital prevalence stands at (1.0%). There were ratio was 1.5:1 however some studies found female preponderance
81(60.9%) males and 52(39.1%) females in ratio 1.5:1. Children [2]. Children age 0-15 constitute 55(41.3%) while young adults and
age 0-15 constitute 55(41.3%) while young adults and adults were adults were 778(58.6%) of all cases of otitis externa. Similar finding
78(58.6%). The minimum age at presentation was one years while was reported by David et al [7] in which he found peaks in cases of
maximum age was 64 years. Mean age was 24.years with a Otitis externa in persons 7- 12 years of age. Rowland et al [2] also
standard deviation of ± 1.12 Years. Majority presented within two reported diagnosis of otitis externa to be common in all age groups
weeks of onset of symptoms 104(78.2%), while 21.8% presented and, except in the elderly however, the sex preponderance in his
within 3 weeks and above. Children aged 0-15 years constitute study was female. Bilateral ear involvement was noted in only
55(41.3%) while young adults and adults were 78(58.6%) of all 10(7.6%) and right or left ears were affected in 66(49.6%) and
cases of otitis externa as shown in Table 1 on page 9. Bilateral ear 57(42.9%) respectively. A study of community pseudomonas
involvement was noted in only 10(7.6%) and right or left ears were infection in Beirut, Lebanon by Usamah H et al [8], show that they
affected in 66(49.6%) and 57(42.9%) respectively. Ear pain as only were mostly associated with otitis externa and the patients had
presenting symptom was the major complain found in this study either unilateral or bilateral otitis externa. Table 2 on page 10 show
accounting for 68(51.1%) (Table 2). This is closely followed by ear ear pain was the major complain found in this study accounting for
pain and associated discharge seen in 35(26.3%) of the cases. Ear 68(51.1%). This is closely followed by ear pain and associated
pain and itchiness was documented in 27(20.3%) while discharge, discharge seen in 35(26.3%) of the cases. Ear pain and itchiness
itchiness and pain in 2(1.5%). Vesicular ear lesions, ear pain were was documented in 27(20.3%) while discharge, itchiness and pain
documented in 1(0.8%). As shown in Table 3 on page 11, acute were the presenting symptoms in 2(1.5%) patients. Studies
diffuse otitis externa was the commonest diagnosis accounting for conducted by Paul et al [9] also found the common presentation to
101(75.9%) and 57(54.9%) cases had clinical findings ranging from range from mild discomfort, itching, and minimal oedema to severe
tragal tenderness, hyperaemia and oedema of ear canal. Twenty- pain, complete canal obstruction, and involvement of the pinna and
eight (27.45%) had in addition discharging ears. Ear wax and surrounding skin. Pain is the symptom that best correlates with the
foreign bodies were documented in 9(8.8%) and 3(2.9%) severity of disease [9].
respectively. There were 7(5.3%) cases of acute localized otitis
externa (furunculosis). Chronic otitis externa and associated clinical Acute diffuse otitis was the commonest diagnosis made followed by
findings of debris, scaly skin (dermatitis) was found in 20(15.4%). chronic otitis externa and acute localized otitis externa. David et al
Few cases of malignant otitis externa, trauma to ear canal and in their study in United States found acute otitis externa to be much
herpes zoster oticus were also documented. Ear swab for more common compared to chronic otitis externa [7]. Ear swab for
microscopy culture and sensitivity in discharging ears 38(28.6%) microscopy culture and sensitivity in discharging ears 38(28.6%)
was not routinely done. Only 6(15.8%) of the discharging ears had was not routinely done. Only 6(15.8%) of the discharging ears had
microscopy done and the organisms were Pseudomonas spp and microscopy done and the organisms were Pseudomonas spp and
klebsiella while 32(84.2) had none. The ears that were not klebsiella while 32(84.2) had none. The ears that were not
discharging constitute 95(71.4%). Majority of cases 84 (63.2%) discharging constituted 95(71.4%). Majority of cases 84 (63.2%)

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were treated with both topical and systemic drugs, while 38(28.6%) Tables
and 11(8.3%) were treated with only topical or systemic drugs
respectively. No surgical procedure was required other than ear
Table 1: age and sex distribution
syringing and wig dressing in few cases. Medline systematic review
Table 2: diagnosis versus presenting symptoms
of the effects of empirical and prophylactic treatments for otitis
Table 3: diagnosis versus clinical examination finding
externa showed that oral antibiotics, specialist aural toilet, topical
acetic acid drops or spray, topical aluminum acetate drops, topical
antibacterial, topical antifungals, topical anti-infective agents, topical
corticosteroids, and water exclusion were effective in managing References
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Table 1: age and sex distribution
SEX
AGE (YEARS) TOTAL N (%)
MALE FEMALE
0-15 39 16 55 (41.3)
16-30 13 19 32(24.1)
31-45 15 12 27(20.3)
46-60 12 5 17(12.8)
61-75 2 0 2(1.5)
>75 0 0 0(0)
TOTAL N (%) 81 (60.9) 52 (39.1) 133 (100)
N=Number of patients, %= Percentage of patients

Table 2: diagnosis versus presenting symptoms

EAR PAIN EAR PAIN
EAR EAR PAIN EAR PAIN EAR
DISCHARGE RASHES AND
DIAGNOSIS PAIN DISCHARGE ITCHINESS ITCHINESS
ITCHINESS DISCHARGE
ACUTE DIFFUSED
63 27 9 2 0 0
OTITIS EXTERNA
ACUTE LOCALISED
3 4 0 0 0 0
OTITIS EXTERNA
CHRONIC OTITIS
1 0 1 0 18 0
EXTERNA
NECROTISING OTITIS
0 2 0 0 0 0
EXTERNA
HERPES ZOSTER
0 0 0 0 0 2
OTICUS
TRAUMA 1 0 0 0 0 0
TOTAL N (%) 68(51.1) 33(24.8) 10(7.51) 2(1.5) 18 (13.53) 2(1.5)
N= Number of patients, %= Percentage of patients

Table 3: diagnosis versus clinical examination finding

Hyperaemia
Impa Tragal Vesicles mass Debris
Discharge Oedema foreign Total
DIAGNOSIS cted tenderness and oedema Scaly
oedema tragal body N (%)
wax debris oedema discharge Ear canal
tenderness
Acute diffused
otitis externa 9 28 8 53 0 0 3 0 101 (78.9)

Acute localized
0 4 0 3 0 0 0 0 7(5.3)
otitis Externa
Chronic otitis
0 1 4 1 0 0 0 14 20(15.03)
externa
Malignant otitis
0 0 0 0 0 1 0 0 1(0.8)
Externa
Herpes zoster
0 0 0 0 0 0 0 2(0.8)
oticus 1
N= Number of patients; % = percentage of patients

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