About External Otitis (Outer Ear Infection)

Overview

External otitis, also known as otitis externa, is a condition characterized by inflammation and infection of the skin in the external auditory canal (ear canal). It typically occurs as a result of bacterial infection or much less commonly a fungal (yeast) infection. Other factors such as excessive moisture, trauma, or allergic reactions can also contribute to its development. Symptoms of external otitis may include severe ear pain, itching, redness, swelling, discharge, and temporary hearing loss. The condition can be acute or chronic, with chronic cases lasting for more than three months. Treatment often involves cleaning the ear canal, using antibiotic or antifungal eardrops to clear the infection, and managing any underlying factors that contribute to the condition. It is important to seek medical attention for proper diagnosis and treatment.

Causes and Risk Factors

The pathophysiologic causes of external otitis include:

Inflammation of the skin of the external auditory canal
Secondary bacterial and/or fungal infection of irritated skin of the ear canal
Changes in the superficial skin layers, which can lead to infection

The non-modifiable risk factors of external otitis are:

Systemic conditions such as anemia, low vitamin concentration, endocrine disorders (especially diabetes), and dermatitis (such as seborrhea, psoriasis, and eczema)

The modifiable risk factors of external otitis are:

Poor hygiene practices, including excessive cleaning or scratching of the ear canal
Swimming in contaminated water or prolonged exposure to moisture
Using objects such as cotton swabs or earplugs that can damage the skin or introduce bacteria/fungi into the ear canal

It's important to note that these risk factors can increase the likelihood of developing external otitis, but they do not guarantee its occurrence. Maintaining good ear hygiene and avoiding exposure to known irritants can help reduce the risk. If you have concerns about your risk for external otitis, it's best to consult with a healthcare professional for personalized advice.

Symptoms

The most common early symptoms of external otitis (swimmer's ear) include:

Redness and swelling in the outer ear and ear canal
Pain in the affected area
Itching and irritation in and around the ear canal
Watery or pus-like discharge, which may have a bad smell
Tenderness when moving the ear or jaw

As external otitis progresses or becomes more severe, additional symptoms may occur:

Scaly skin that may peel off in and around the ear canal
Sore and swollen lymph nodes in the throat
Some hearing loss if there is significant swelling inside the ear

It's important to note that these symptoms can vary from person to person. If you are experiencing any of these symptoms, it is recommended to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.

Diagnosis

To diagnose external otitis, the following examinations, tests, and procedures are commonly performed:

Clinical examination: A healthcare provider examines the ear using an otoscope to look for signs of inflammation, redness, swelling, discharge, or any other visible abnormalities.
Specimen collection: If necessary, a sample of the ear discharge may be collected for further analysis.

To determine the stage or severity of external otitis, additional examinations, tests, and procedures may be performed:

Direct examination and culture: The collected specimen is examined under a microscope to identify any molds or yeast present. Culturing the specimen helps identify the specific microorganism causing the infection.
Radiological examination (CT scan): A computed tomography (CT) scan may be used to assess the severity of the condition and evaluate any potential damage to the bones or complications such as tegmen dehiscence or labyrinthine fistulas.

It's important to note that the specific examinations, tests, and procedures may vary depending on individual cases. Your healthcare provider will determine which ones are necessary based on your symptoms and medical history. Remember to consult with your healthcare provider for personalized advice.

Treatment Options

The goals of treatment for external otitis (ear infection) are to alleviate symptoms, eliminate the infection, and prevent complications. Here are the various treatment options and how they work to achieve these goals:

Medications:

Antibiotics: Topical or oral antibiotics may be prescribed to fight the infection. They work by killing or inhibiting the growth of bacteria causing the infection.
Bacteriophage suspension: This is a type of therapy where a suspension containing bacteriophages (viruses that infect bacteria) is applied locally to target and eliminate specific bacteria causing the infection.

Therapeutic procedures:

Tympanic membrane repair: In cases where there is damage to the eardrum, surgical repair may be performed to restore its integrity and prevent further complications.

Health behavior changes:

Keeping the ear dry: Avoiding swimming and using a shower cap while bathing can help prevent moisture from entering the ear, which can worsen the infection.
Gently removing discharge and debris: Under a doctor's supervision, using cotton wool to clean the outer ear can help clear away any discharge without causing further irritation.

It's important to note that treatment approaches may vary depending on the severity and underlying cause of external otitis. It is recommended to consult with a healthcare professional for personalized advice. Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for side effect information.