Pain when swallowing pressure

Specialty: Otolaryngology.

• Positive swallow sign
• pain when pulling the auricle
• anterior auricular cartilage pain

Why it occurs

• Acute diffuse external otitis of bacterial origin (mainly due to Pseudomonas aeruginosa or Staphylococcus aureus)
• Circumscribed external otitis or boil of the external auditory canal in its lateral cartilaginous portion
• Perichondritis of the pinna secondary to trauma, piercing or local lacerations
• Active inflammatory arthropathy or acute mechanical dysfunction of the temporomandibular joint that mimics the location
• Deep erosive otomycosis of the skin of the external auditory canal

Initial workup

Careful otoscopy with a narrow speculum to avoid excessive pain, culture of the purulent exudate obtained from the external auditory canal for antibiogram, blood analysis with acute phase reactants (CRP and immunoglobulins if recurrent perichondritis is suspected), and craniofacial CT if there is suspicion of progression to malignant otitis externa.

Standard management

• Ciprofloxacin 0.3% ear drops with dexamethasone 0.1% — 4 drops in the affected duct every 8 hours for 7-10 days
• Systemic analgesics such as dexketoprofen — 25 mg every 8 hours orally depending on the intensity of pain, with gastric protector if necessary
• Systemic antibiotic therapy with ciprofloxacin — 500-750 mg every 12 hours orally if there is involvement of perichondritis or skin extension
• Antibiotic creams with 2% mupirocin (applied at the entrance of the duct if it is a localized boil).