Otitis externa, or an infection of the outer part of the ear, is often called "swimmer's ear" because it commonly occurs after frequent immersion of the ears in water.  The ear canal is normally protected by a waxy substance referred to as cerumen (or ear wax).  When the protective secretions of the ear canal are washed away, bacteria can cause an infection.   The main symptom of otitis externa is ear pain, which may be severe.  The affected ear also has decreased hearing due to swelling.  Eardrop antibiotics and corticosteroids help treat infection and inflammation.  Inserting a "wick," a small piece of soft material that can be inserted into a swollen ear canal, helps distribute the medicine.

  

What is otitis externa?

Otitis externa is an infection of the ear canal.  It is often called "swimmer's ear" because it may occur after the protective secretions of the ear canals are washed away by frequent swimming.  However, other water exposure such as bathing, showering and ear washes can have the same effect.  Otitis externa may also occur without any water exposure, especially when a fungus is the cause.

 

What is otitis media?

Otitis media is an infection of the middle part of the ear.  See otitis media.

What causes otitis externa?

Either a bacterial or fungal infection.  The most common bacteria type is Pseudomonas aeruginosa.  This infection develops quickly and causes swelling and intense pain.  Fungal infections frequently occur more slowly over time and are less painful.

What are the symptoms of an ear infection?

• Ear itching (early in the illness)
• Ear pain (can be intense).  Pressing or pulling the outer ear (the pinna) can cause worsening of the pain.
• Drainage from the ear which may be yellow, brown or whitish
• Hearing loss (due to ear canal swelling)

Red Flags (seek medical care immediately)

• Severe or persistent symptoms
• High fever
• Symptoms in an infant
• Dizziness or clumbsiness
• Visible swelling around the ear
• Lethargy or unsual behavior

How is otitis externa diagnosed?

The diagnosis of otitis externa is usually obvious by the patient's history.  An otoscope can be used to look inside of the ear canal.  For rapid-onset otitis externa, the ear canal is often swollen shut.  If the canal is open, the examiner can often see soft light-colored secretions in the ear canal with redness and irritation.  If a fungal infection is present, fluffy white or black debris may be seen.  The ear drum should be examined, if possible, to determine if there is also an otitis media and/or a perforated ear drum with drainage.  Pressure on the outer part of the ear is typically painful, whereas this usually does not cause discomfort in a middle ear infection.

How is otitis externa treated?

Bacterial 

• Ear drop antibiotics such as neomycin/polymyxin or ciprofloxicin are commonly used.  If the ear canal is swollen shut, then a wick may be inserted to allow for better distribution of the medicine.
• Ear drop corticosteroids help reduce inflammation.

Fungal

• Ear drop antifungals such as clotrimazole or nystatin are often prescribed.

Ear wash solutions with dilute alcohol or dilute acetic acid can help remove debris and allow for better distribution of medicines.

Pain medicines such as ibuprophen or codeine may be necessary.

What are the complications of otitis externa?

Complications of otitis externa are uncommon, however, they include:

• Chronic ear infection
• Mastoiditis - infection in the bone around the ear
• Inner ear infection - causing dizziness, clumbsiness, nausea, vomiting, and/or hearing loss
• Abscess formation

Can otitis externa be prevented?

• Avoid frequent ear washing
• Avoid frequent water filling the ear (wear ear plugs while swimming)
• Use ear drops solutions with dilute alcohol or dilute acetic acid after water exposure