Otitis externa (outer ear infection)

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Description

Otitis externa is an infection of the skin of the ear canal and is very common. It often occurs out of the blue for no apparent reason. Otitis means inflammation of the ear. Otitis externa means that the inflammation is confined to the ear canal and does not go further than the eardrum. The most characteristic symptom is discomfort that is limited to the external auditory canal, while the most characteristic signs are erythema and swelling of the canal with variable discharge.

The symptoms of otitis externa can vary between cases. Common symptoms include itch, ear discharge, temporary dulled hearing and pain. The ear may feel blocked or full. One or both ears can be affected.

Causes and Risk factors

Otitis externa is most commonly caused by infection (usually bacterial, although occasionally fungal), but it may also be associated with a variety of noninfectious systemic or local dermatologic processes. Excessive moisture and trauma, both of which impair the canals natural defenses, are the two most common precipitants of otitis externa, and avoidance of these precipitants is the cornerstone of prevention.

Possible causes may include:

1. Swimming. Otitis externa is five times more common in regular swimmers compared with non-swimmers. It is due to the water which gets into the ear canal. In fact, otitis externa is sometimes called swimmers ear.

2. Weather. Otitis externa is more likely to develop in hot, humid, and sweaty weather. It is more common in hot countries.

3. Skin problems. Eczema or psoriasis may affect the ear canal and cause an otitis externa.

4. Ear syringing to clear earwax. This may irritate the ear canal and cause inflammation.

5. Middle ear infections. Sometimes middle ear infections (otitis media) can produce some discharge for some time which can then cause otitis externa.

Diagnosis and Treatment

Most physicians prescribe topical antibiotics. Before antibiotic treatment was recommended for otitis externa, astringents and acetic acid solutions (VoSol) were commonly used to treat otitis externa. These solutions can be painful to inflamed ear canals and are not generally used today. An aminoglycoside combined with a second antibiotic and a topical steroid such as neomycin-polymyxin B-hydrocortisone used to be the most commonly prescribed topical antibiotic. However, caution must be used to recognize a hypersensitivity reaction and ototoxicity to the neomycin component.

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