Otitis externa (patient information)
Otitis externa On the Web
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Otitis externa, often known as "swimmer's ear," is an inflammation of the external ear canal. The inflammation often begins when the skin in the outer ear becomes damaged and predisposed to infection by bacteria. It is usually caused by a bacterial infection from bacteria-contaminated water that enters the ear canal when an individual is swimming, diving, or performing other aquatic activities. Otitis externa can also be caused by a fungal infection, as well as allergies or exposure to chemical irritants causing otitis externa through eczema or seborrhea. Malignant otitis externa is a very rare form of the disease where the infection spreads past the ear canal and into ear and skull-base bones.
What are the symptoms of Otitis externa?
Common symptoms of otitis externa include the following:
- Ear pain
- Ear itching
- Ear canal swelling
- Ear canal redness and pressure
- Fluid discharge
- Scaley skin in the ear canal
- Partial hearing loss
Less common symptoms that are specific malignant otitis externa include the following:
What causes Otitis externa?
Otitis externa is caused by sources of inflammation to the external ear:
- Bacterial and fungal infections from trapped water in the ear canal.
- Spread of skin conditions such as eczema.
- Excessive or abrasive use of cotton swabs, Q-tips etc. that scratch and damage the skin of the ear canal.
- Growth of the bone in the ear canal from persistent water pressure (also known as surfer's ear).
- Chemical irritants in cosmetic products, such as soaps or shampoos.
- Lack of earwax from excessive cleaning.
- Prolonged exposure to excessive humidity.
- A weakened immune system in the case of malignant otitis externa.
Who is at highest risk?
- Swimmers and scuba divers.
- People living in humid, tropical climates.
- People with allergies or inflammation-based skin conditions, such as eczema or psoriasis.
- People who use ear plugs or other in-ear devices consistently.
- People who have experienced a traumatic physical injury to the ear, such as a blunt impact.
- People with narrow ear canals.
- For malignant otitis externa, people with diabetes mellitus or undergoing chemotherapy due to weakened immune system.
- Elderly women between 65 and 74 years old.
- A physical examination of the ear canal will diagnose otitis externa based on signs of redness, swelling, scaley skin, and fluid discharge.
- For malignant otitis externa, a CT or radioactive bone scan will determine if the infection causing otitis externa has spread past the ear canal.
- A complete blood count test may be administered to confirm presence of inflammation.
When to seek urgent medical care?
- Ear pain does not subside after several weeks.
- Hearing loss becomes severe.
- Fever or flu-symptoms develop.
- It becomes difficult to swallow or to move the neck or jaw.
- It becomes difficult to breathe.
- Dizziness develops.
- Eardrop antibiotics to be applied directly to the outer ear to treat bacterial infection.
- Eardrop antifungal agents applied directly to the outer ear to treat fungal infection.
- Pain relievers, such as tylenol or aspirin
- Non-abrasive devices to clean and dry the ear canal
- Oral antibiotics in the case of malignant otitis externa
Where to find medical care for Otitis externa?
- Avoiding swimming in contaminated water
- Avoiding inserting cotton swabs or abrasive cleaning materials into the ear canal.
- Avoiding excessively prolonged use of antibiotic ear drops to prevent fungal infection.
- Wearing swimming caps or ear plugs when swimming.
- Avoiding prolonged exposure to excessive humidity.
- Using battery-powered ear dryers to dry the ear canal without causing irritation.
- Administering burow's solution
- Avoiding irritants or allergens in the ear canal to prevent skin conditions such as eczema or psoriasis
What to expect (Outlook/Prognosis)?
- The prognosis for otitis externa is usually good with or without treatment. Recurring episodes may require treatment to resolve symptoms permanently. Malignant otitis externa has a poor prognosis without treatment; with treatment, the prognosis varies depending on the extent of infection and damage caused to the skull bones and nerves.
- Perforated ear drum.
- Skin rash
- Narrowing of the ear canal (Surfer's ear)
- Buildup of pus in the ear canal
- Bone infection and inflammation
- Facial paralysis