WHAT IS IT?
Otitis externa, also known as "swimmer's ear," is an inflammation of the skin of the external ear canal and the folds of skin and cartilage that make up the part of the ear that is visible (auricle or pinna). The condition is usually caused by a bacterial infection but is sometimes caused by fungal infection. Occasionally, chronic otitis externa is caused by a
dermatitis such as seborrhea,
eczema, or psoriasis. External otitis occurs most commonly in young adults.
HOW IS IT DIAGNOSED?
History: The individual complains of moderate to severe external ear pain. The pain may be worse when clenching the teeth, opening the mouth, or chewing. Recent water exposure or mechanical trauma to the affected ears is often described. Other symptoms may include fever, foul-smelling discharge from the ear (otorrhea), and partial hearing loss. In chronic external otitis, itching rather than pain is the chief complaint.
Physical exam: The use of an otoscope will reveal a swollen external ear canal. Tender lymph nodes in front of or behind the external ear (periauricular lymphadenopathy) are usually present. Pain on palpation of external ear structures distinguishes otitis externa from middle ear infection.
Tests: A sample of the discharge may be submitted to the laboratory to identify a bacterial infection.
HOW IS IT TREATED?
Initially, pain can be eased with heat applied to the area along with analgesics. The physician will probably clean the ear canal. Eardrops containing a corticosteroid preparation and an antibiotic are prescribed. If fever persists or regional inflammation (cellulitis) develops, oral antibiotics are prescribed. While the condition is healing, the ear must be protected from moisture and further scratching must be avoided.
WHAT MIGHT COMPLICATE IT?
The condition may recur a number of times over a period of months, especially if it is caused by a fungus. Severe chronic otitis externa may reflect underlying diabetes, underactive thyroid, or kidney infection.
PREDICTED OUTCOME
Appropriate treatment will provide improvement in three or four days.
ALTERNATIVES
Other common causes of drainage from the external ear canal include seborrhea,
psoriasis,
acute otitis media,
basal cell carcinoma, neurodermatitis, furunculosis, and a foreign body (in the ear).
APPROPRIATE SPECIALISTS
Dermatologist, infectious disease specialist, and otolaryngologist.
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