About otitis externa
Otitis externa is a painful condition that is common in swimmers and is often called “Swimmer’s ear”. Otitis externa is caused by bacterial or fungal infection of the ear canal, as a result, the canal becomes red, hot and swollen, and this inflammation is what causes the pain. The ear canal is the part of the ear which is between the outer ear and the ear drum; it is lined with skin, and is the part of the ear where wax is produced.
Signs and symptoms
One of the most common presenting symptoms of patients with otitis externa is pain in the ear canal and also the pinna (the external part of the ear). Patients with otitis externa are very sensitive to pain in the outer parts of the ear, and pain is elicited when the pinna is moved or has pressure applied to it. In people with severe cases of otitis externa, even very light touch or slight movements of the ear will cause pain.
This is different to patients with middle ear infections (otitis media), where movement of the pinna is unlikely to elicit pain and it is common for people with otitis externa to experience sleep disturbances due to their pain. The ear and the ear canal may also feel itchy. Despite feeling itchy, blocked and uncomfortable, it is important for a patient with otitis externa to avoid cleaning their ears with a cotton bud or similar, as this can cause injury and exacerbate the problem, as well as potentially introducing further bacteria which can worsen the infection.
Patients with otitis externa may also experience temporary hearing loss. This is due to discharge and pus in the ear canal. Significant swelling and pus in the ear canal may cause a blockage leading to a degree of hearing loss; this is reversible once the condition has subsided. The pus is often foul smelling and unpleasant. As it is caused by an infection, patients with otitis externa may feel unwell, tired and lethargic, and may have a fever. Less commonly, patients may also report tinnitus (ringing in the ears) and other noises in the ear.
Excessive moisture and /or trauma to the ear canal are common predisposing factors to otitis externa. Moisture can accumulate in the ear canal in a number of ways, with swimming being the most common. In addition, exposure to humidity and excessive sweating may also increase the moisture in the ear canal, this interferes with the normal protective mechanisms which exist in the ear canal to protect against infection.
Moisture can remove the earwax, which is important for trapping bacteria and creating a slightly acidic environment, which impedes bacterial growth. With moisture and loss of earwax, the pH of the canal changes and makes it easier for bacteria to multiply and cause infection.
The ear canal can be affected by trauma in several ways. Cleaning of the ears with cotton buds or similar can injure and irritate the ear canal. Ear plugs may also damage the lining of the canal and leave the patient vulnerable to otitis externa. Patients with skin conditions, such as eczema and psoriasis, may also experience irritation of the ear canal and any trauma that damages the integrity of the skin can facilitate bacterial growth and entry.
Ear infection treatment
Cleaning of the ear canal is an important part of treatment; but needs to be performed carefully to avoid further injury or damage to the ear canal. Gentle suction is the preferred method of removing debris and secretions from the ear canal. Ear flushing should also be avoided, as this may cause damage to the ear drum and middle ear. In cases of severe swelling and obstruction, a wick may be inserted.
Once the ear canal has been cleaned, topical antibiotics are applied to the ear. Antibiotics are used to clear the underlying infection, and if combined with a steroid medication, can reduce the inflammation in the ear canal, these are commonly given as ear drops. Oral antibiotics are not required in most cases of otitis externa, but are prescribed if the infection has spread beyond the ear canal, or the infection is recurrent. They are also prescribed if there is also a middle ear infection present.
Complications and consequences
A severe form of otitis externa, called malignant otitis externa, causes the temporal bone surrounding the ear to be infected also. This is an infection similar to osteomyelitis, and primarily affects patients with a poorly functioning immune systems, such as those with diabetes. There is a high mortality rate with this condition due to its relative difficulty to treat.
Furthermore, in some instances, otitis externa may become chronic and cause changes to the skin of the ear canal making it is possible for the infection to spread to surrounding areas of the body. Generally, these problems do not occur in healthy individuals who receive appropriate treatment.
If you have any questions or concerns about ear infection or otitis externa contact you local doctor, who will arrange for you to see an ear nose and throat specialist.