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Otitis Externa

(Swimmer’s Ear)

Definition

Otitis externa is an inflammation and/or infection of the ear canal. The ear canal is the tube leading from the outer ear to the eardrum. Because it is often found in swimmers, particularly in warm, humid climates, it is often referred to as swimmer’s ear.

Regions of the Ear

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Copyright © Nucleus Medical Media, Inc.

Causes    TOP

Otitis externa is caused by infection, chemical irritation, or trauma. Trauma causes damage to the ear canal, which may cause inflammation or allow infection to invade.

Risk Factors    TOP

Factors that may increase your chance of otitis externa include:

  • Frequent swimming in chlorinated water, stagnant water, or increasingly warm water
  • Not rinsing all of the soap from the ear canal while showering or bathing
  • Younger age with narrow ear canals
  • Insertion of any object into the ear canal causing damage to the lining
  • Skin conditions, such as eczema, that cause breaks in the skin of the ear canal
  • Eardrum rupture from a middle ear infection—otitis media
  • Diabetes
  • Medical conditions resulting in a compromised immune system

People with weak immune systems or who have a chronic illness, such as diabetes or HIV, may get an aggressive form called malignant otitis externa. Malignant otitis externa results in infection of the cartilage and bone around the ear, as well as between the ear and the brain (the skull base). The condition can be severe and difficult to treat, causing nerve paralysis.

Symptoms    TOP

Otitis externa may cause:

  • Redness and/or itching inside the ear canal
  • Pain in the ear, sometimes severe, that may worsen when chewing or talking, and with pulling on the ear
  • Hearing loss or a plugged-up or pressure sensation of the ear
  • Drainage from the ear

Diagnosis    TOP

You will be asked about your symptoms and medical history, and perform a visual exam of the ear, including the ear canal and inner ear, using a lighted device called an otoscope. If malignant otitis externa is suspected, a CT scan may be necessary.

Treatment    TOP

This condition can easily be treated, but can become serious and life-threatening in some people, if left untreated. This can be very serious particularly in people with diabetes, where the infection can spread and cause malignant otitis externa.

Options may include:

Medications

For those with an infection, medication will depend on the cause of the infection. Other medications will help reduce other symptoms, such as pain and inflammation. The doctor may advise:

  • Oral nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
  • Antibiotic ear drops to treat any infection
  • Oral antifungal medications to treat fungal infections
  • Oral antibiotics to treat severe infections or cellulitis of the ear canal
  • Corticosteroid ear drops to reduce inflammation (this may be combined with an antibiotic ear drop)
  • Intravenous antibiotics for malignant otitis externa

If the ear canal is very swollen, it may not allow the ear drops to get in. A small sponge, called a wick, may be inserted in the ear canal to absorb the drops. It is usually removed after 24-48 hours.

Drainage

If medications or ear wash do not work, your doctor may need to remove any drainage or pus from the ear canal. However, this is rarely needed.

Surgery    TOP

Malignant otitis externa requires immediate treatment, hospitalization, intravenous antibiotics, and possibly surgery. Surgery may be indicated for:

  • Infection that has spread to the base of the skull
  • Bone abscess
  • Failure of other treatment methods

Debridement, the removal of dead tissue, may also be necessary to help the healing process.

Other Suggestions    TOP

The doctor may also advise:

  • Keeping the ear dry for 7-10 days
  • Taking baths instead of showers
  • Avoiding swimming
  • Avoiding rubbing or scratching the ear or inside the ear canal
  • Avoiding using hearing aids or earplugs until you are healed

Prevention    TOP

To help reduce your chance of otitis externa, or from having the condition recur:

  • Avoid swimming in unclean water.
  • Thoroughly drain and dry the ear and ear canal after swimming or showering.
  • When showering, gently place a cotton ball lightly coated with petroleum jelly into the outer ear to prevent water collection.
  • Do not insert anything into the ear canal, including your finger or cotton swabs.
  • Do not remove earwax. If you are having problems hearing, see a doctor first.
  • Limit use of earplugs since they can irritate the lining of the ear canal and can trap water inside the ear.
  • Consider using a tight-fitting swimming cap.
  • Use a white vinegar/rubbing alcohol ear drop solution following swimming, or glycerin drops before and after swimming. This will help restore the natural healthy environment inside the ear canal.

RESOURCES:

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org
Family Doctor—American Academy of Family Physicians
http://familydoctor.org

CANADIAN RESOURCES:

Canadian Society of Otolaryngology
http://www.entcanada.org

References:

Otitis externa. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116943/Otitis-externa. Updated December 18, 2014. Accessed August 22, 2017.
Otitis externa (swimmer's ear). National Center for Emergency Medicine Informatics website. Available at:
...(Click grey area to select URL)
Accessed August 22, 2017.
Prentice P, et al. American Academy of Otolaryngology: head and neck surgery foundation clinical practice guideline on acute otitis externa 2014. Arch Dis Child Educ Pract Ed. 2015 Aug;100(4):197.
Rosenfeld RM. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. 2014 Feb;150(2):161-8.
Swimmer’s ear. American Academy of Otolaryngology—Head and Neck Surgery website. Available at:
...(Click grey area to select URL)
Accessed August 22, 2017.
Swimmer’s ear (otitis externa). Centers for Disease Control and Prevention website. Available at:
...(Click grey area to select URL)
Updated May 4, 2016. Accessed August 22, 2017.
Last reviewed September 2017 by EBSCO Medical Review Board Michael Woods, MD FAAP
Last Updated: 9/30/2013

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