Otitis externa

Otitis externa

Otitis externa is a common condition. It is characterized by inflammation of the skin of the external (outer) ear canal. It can be very painful. The acute form has a sudden onset and often occurs in relation to the exposure to water (swimmers ear). Chronic otitis externa, lasts for a longer period of time and is usually less painful.

Fungal otitis external
Fungal otitis externa (“wet newspaper look”).

It is believed that up to 1% of the population may suffer from otitis externa per year. External otitis occurs when the skin of the ear canal is inflamed or injured. The inflammation may be due to skin conditions such as eczema or psoriasis. Self-cleaning of the ears with instruments or ear buds may damage the skin and create an entry point for bacteria. In some patients accumulation of earwax may predispose to fungal infections. Humid conditions and a lot of swimming are associated with swimmers ear.

Patients with diabetes, immunosuppression and those who have had radiotherapy may get recurrent episodes of external otitis.

Besides pain the patient may also have hearing loss, discharge, vertigo, dizziness, swelling of glands and redness or crusting of the ear. Slight pulling of the ear causes an increase in the pain.

The treatment consists of pain medication, cleaning of the ear canal and antibiotics. Topical antiseptic ear drops and topical anti biotic drops are more affective than oral antibiotics. Some drops contain steroids. If swelling is severe a wick may be placed for a few days to keep the drops in constant contact with the inflamed skin.

Necrotizing otitis externa (malignant otitis externa) is a rare form of otitis externa that occurs in some immunocompromised patients. It is serious and spreads rapidly outside the ear canal to the skull base and parotid gland. It destroys bone, causes nerve paralysis and requires aggressive early treatment. Intravenous antibiotics and surgery are usually necessary.