Otitis Externa (Inflamed Outer Ear, Swimmer’s Ear)

Definition

Otitis externa is the inflammation of the external ear which includes the ear canal. It may be acute or chronic.The condition is very common in people who are frequently immersed in water, like swimmers and divers. Therefore otitis externa is commonly referred to as swimmer’s ear. Inflammation of the outer ear is mainly due to an infection but various skin conditions can also be a cause. The condition is frequently seen in children, especially those who tend to swim on a regular basis.

Types

Otitis externa can be divided into the following types:

Infectious

  • Bacterial.
  • Fungal (otomycosis).
  • Viral.

Non-infectious

  • Eczematous otitis externa.
  • Seborrheic otitis externa.

Symptoms

  • Pain, which is the presenting symptom which can be severe as the skin is intimately adherent to the underlying cartilage. Pain could also be present on movement of the external ear.
  • Foul smelling and pustular discharge.
  • Hearing loss associated with a collection of discharge and debris in the external canal.
  • Ringing of ears (tinnitus) may be present at times.
  • Itching and discomfort.
  • Locking of the jaw may be present with severe pain on opening of the mouth.
  • Swelling. Generalized swelling may be present which may spread. The pinna may appear red and swollen, with one side being larger than the other.

In fungal infections there could be yellowish white specks visible on examining the ear canal. In herpes (viral), herpetic vesicles in the external auditory canal along with paralysis of the facial nerve or other cranial nerves can occur.

Weeping eczema, fissuring and scaling, along with other symptoms of otitis externa can be seen in eczematous otitis externa. Greasy, scaly and crusty skin of the external ear is seen in seborrheic otitis externa. Myringitis or infection of the external surface of the eardrum can cause symptoms similar to otitis externa such as pain, deafness and tinnitus.

Causes

A mere scratch on the external ear can get infected and cause otitis externa. Water entering the ear can carry with it organism which may cause otitis externa. It can also be caused due to damp climate. Swimmers and people living in damp climate can be considered to be at more risk of getting the disease.

Discharge from the middle ear can cause secondary infections of the external auditory canal.Diabetes can cause severe otitis externa (malignant otitis externa) which may also involve the cranial nerves and result in paralysis. Infections of the hair follicle or sebaceous gland can cause boils and in turn can cause otitis externa.

Treatment

Antibiotic ear drops useful when pus discharge is present. Drops containing antibiotics with steroids are helpful in reducing the swelling. As bacteria hampers the growth of fungus, antibiotics drops should be discontinued in fungal infections. Antifungal agents like clotrimazole, tolnaftate or salicylic acid could be used.

Eczematous otitis externa is treated with steroids, antibiotics both locally and orally, and antihistamines. In chronic conditions of eczematous otitis externa if fissures are present, 10% silver nitrate is applied. Dilation of stenosis by indwelling polyethylene tubes or plastic surgery may be required.

Seborrheic otitis externa is treated with steroids and antibiotics. The scales from the ear are removed along with any hair if present and good hygiene of the scalp is maintained.

Oral analgesics and antibiotics along with anti-pruritic agents are usually given in all types of otitis externa. Ear hygiene is to be maintained by cleaning all the collected debris repeatedly. The treatment may be needed to be given for two weeks for full resolution.

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