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| Specialty | Otorhinolaryngology  |
Otitis externa (also called swimmer's ear or ear ache) is an inflammation, irritation, or infection of the outer ear and ear canal.
Causes, incidence, and risk factors
Otitis externa is fairly common, especially among teenagers and young adults. Swimming in polluted water is one way to contract swimmer's ear, but it is also possible to contract swimmer's ear by swimming in a pool that is well maintained or even from water trapped in the ear canal after a shower, especially in a humid climate. Water trapped in the ear canal is not the only cause, however -- the condition can be caused by scratching the ear or an object stuck in it. Trying to clean wax from the ear canal, especially with cotton swabs or small objects, can irritate or damage the skin. It is occasionally associated with middle ear infection (otitis media) or upper respiratory infections such as colds. Middle ear infections can occur after the ear drum is perforated by a fungal growth from the outer ear. Moisture in the ear predisposes the ear to infection from fungus or water-loving bacteria such as Pseudomonas.
Symptoms
- Ear pain -- may worsen when pulling the outer ear
- Itching of the ear or ear canal
- Drainage from the ear -- yellow, yellow-green, pus-like, or foul smelling
- Decreased hearing or hearing loss
Signs and tests
When the physician looks in the ear, it appears red and swollen, including the ear canal. The ear canal may appear eczema-like, with scaly shedding of skin. Touching or moving the outer ear increases the pain. It may be difficult for the physician to see the eardrum with an otoscope. Taking some of the ear's drainage and doing a culture on it may identify bacteria or fungus.
Treatment
The goal of treatment is to cure the infection. The ear canal should be cleaned of drainage to allow topical medications to work effectively. Depending on how severe the infection is, it may be necessary for a doctor to aspirate the ear as many times as twice a week for the first two or three weeks of treatment.
Effective medications include eardrops containing antibiotics to fight infection, and corticosteroids to reduce itching and inflammation. Use of antibiotics to treat ear infections may result in treatment of the wrong cause of the infection because not all ear infections are bacterial; some are fungal, and it is possible to have both a bacterial and fungal ear infection.
Ear drops should be used abundantly (four or five drops at a time) in order to penetrate the end of the ear canal. If the ear canal is very swollen, a wick may be applied in the ear to allow the drops to travel to the end of the canal. Occasionally, pills may be used in addition to the topical medications. Analgesics may be used if pain is severe. Putting something warm against the ears may reduce pain.
Protect ears from further damage. Do not scratch the ears or insert cotton swabs or other objects in the ears. Keep ears clean and dry, and do not let water enter the ears when showering, shampooing, or bathing.
Prognosis
Otitis externa responds well to treatment, but complications may occur if it is not treated. Some individuals with underlying medical problems, such as diabetes, may be more likely to get complications such as malignant otitis externa.
Complications
- Chronic otitis externa
- Malignant otitis externa
- Spread of infection to other areas of the body
Prevention
- Dry the ear thoroughly after exposure to moisture.
- Avoid swimming in polluted water.
- Use earplugs when swimming.
- Consider putting a few drops of a 1:1 mixture of alcohol and white vinegar in the ears after they get wet. The alcohol and acetic acid prevent bacterial growth.
For pool swimmers who swim to keep fit
- Buy an empty bottle with an eye dropper from a drug store.
- Fill the bottle with a solution made from 1 part alcohol and 1 part white vinegar.
- Keep that bottle in your locker or gym bag.
- Forget the earplugs.
- After your swim, draw out all water from your ears thus:
- Stand still.
- Don't jump.
- Tilt your head to one side.
- Use the eyedropper to put enough of the alcohol and vinegar solution to fill one ear.
- Keep the alcohol and vinegar in your ear for 30 seconds.
- To drain the alcohol and vinegar, tilt your head to the opposite side, and use a tissue to catch the effluent.
- The solution may burn slightly; it's not intense.
- The water in your ear will drain out with the alcohol and vinegar.
- Repeat for the other ear.
- Verify that no water remains in either ear by tilting your head from side to side and front to back. If any fluid remains inside your ears, you'll hear it.
- Repeat the steps above if necessary.
- Let the remnants of the alcohol and vinegar air dry on your outer ear.
- Pool swimmers have very clean, wax-free ears because pool water dissolves ear wax.
- If you have an ear itch, use the alcohol and vinegar mixture. Itching is a sign that something foreign is in your ear and that it needs the alcohol and vinegar treatment.
Otitis externa in animals
Animals are commonly prone to ear infection. In dogs, those breeds with floppy ears are more prone, since air flow is limited and a warm, moist environment built up, which is conducive to infection. The external ear in animals is often longer and deeper than in humans, which makes it easier for infection or wax to build up or be hard to remove. Dogs also scratch their ears which can cause infectious agents normally harmless on the skin, to penetrate the defences of the ear's skin if they scratch heavily.
Infections can be of both bacterial and fungal origin, as well as small organisms such as ear mites. Malassezia pachydermatis is a common fungal agent for ear infections in dogs.
A sign of ear infection is brief shaking of the head, and scratching. Ear infections often result in a darker red ear, dirt in the ear, or a general inflammed appearance.
Treatment is usually by a dual regime of ear cleaning, and ear medication. Ear cleaning should be demonstrated by a vet, due to the risk of pushing infected material deeper into the ear.
The aim of cleaning, is to remove any byproducts of the infection which lead to further irritation and discomfort, and may be in turn, causes of further infection. Good care often involves cleaning the ear 2-3 times a day, to prevent build-up and bring the infection under control.
Treatment is then performed a little while time after cleaning, when the ear has cleaned and had time to properly dry, and is usually in the form of ear drops applied daily or twice daily for around a week. In the case of fungal infection, a longer course is sometimes needed. The type of infection must be identified by the vet, under a microscope, since bacterial infection will only respond to antibiotics, fungal infection to a fungicide, and ear mites to an insecticide.
In mild cases, an agent such as Canaural (0.5% diethanolamine fusidate) can help. In more severe cases, especially if a fungal infection is suspected, a combination eardrop such as Aurizon (CAS number 115550-35-1), a combination of Marbofloxacin (a potent antibiotic) and Clotrimazol (an anti-fungal agent) together with Dexamethasone (an anti-inflammatory), may be used.