• Otitis Externa

    (Swimmer’s Ear)

    Definition

    Otitis externa is an infection, inflammation, or irritation of the ear canal, 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. This condition can easily be treated but can become serious, even life-threatening in some people, if left untreated. This can be very serious particularly in diabetics , where the infection can spread to the middle and inner ears, and cause an infection in the bone ( osteomyelitis ), described as malignant otitis externa. Contact your doctor if you think you may have otitis externa.
    The Ear Canal
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    Causes

    Otitis externa can develop under the following circumstances:
    • Following frequent swimming or bathing when the ears are repeatedly filled with water and not drained completely afterward
    • After removal of protective ear wax, especially if the cleaning is painful and causes bleeding
    • Excessive use of cotton swabs to clean ears
    • Injury to the skin in the ear canal
    • As a consequence of skin conditions that also can occur in the ear canal, such as:

    Risk Factors

    A risk factor is something that increases your chance of getting a disease or condition.
    The following factors increase your chance of developing otitis externa:
    • Frequent swimming or showering, particularly in young children who have narrow ear canals
    • Insertion of any object into the ear canal causing damage to the lining
    • Skin conditions causing breaks in the skin of the ear canal
    • Diabetes
    • Medical conditions resulting in a compromised immune system
    People with weak immune systems or who have a chronic illness, such as diabetes or AIDS , may suffer an aggressive form called malignant otitis externa. This life-threatening condition requires immediate treatment, hospitalization, intravenous antibiotics, and surgery (if needed). 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

    If you experience any of these symptoms do not assume it is due to otitis externa. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.
    • 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

    Your doctor will ask 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

    Treatment options include the following:

    Drainage

    Your doctor will remove any drainage or pus from the ear canal using a suction.

    Drug Treatment

    Prescription ear drops containing infection-fighting medications and inflammation reducers, like antibiotics and corticosteroids, are the usual treatment for otitis externa. Sometimes, antibiotic or antifungal pills are prescribed. With treatment, symptoms of otitis externa usually decrease in severity within 24 hours to three days. 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.

    Other Suggestions

    Your doctor may also recommend:
    • Keep the ear dry for 7 to 10 days.
    • Take baths instead of showers.
    • Avoid swimming.
    • Do not rub or scratch the ear or inside the ear canal.
    If you are diagnosed with otitis externa, follow your doctor's instructions .

    Prevention

    To help reduce your chances of getting otitis externa, or from having the condition recur, take the following steps:
    • 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 ear wax. If you are having problems hearing, see a doctor first.
    • Avoid using ear plugs 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 eardrop solution following swimming. This will help restore the natural healthy environment inside the ear canal.

    RESOURCES

    American Academy of Family Practitioners http://www.aafp.org/

    American Academy of Otolaryngology, Head and Neck Surgery http://www.entnet.org/

    CANADIAN RESOURCES

    Canadian Society of Otolaryngology http://www.csohns.com

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    American Academy of Otolaryngology. Swimmer’s ear. American Academy of Otolaryngology website. Available at: http://www.entnet.org/healthinfo/ears/swimmers.cfm . Accessed September 29, 2005.

    Block SL. Otitis externa: providing relief while avoiding complications. J Family Practice . 2005;54(8):669-676.

    DynaMed Editorial Team. Otitis externa. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 20, 2010. Accessed November 10, 2010.

    National Center for Emergency Medicine Informatics. Otitis externa (swimmer's ear). National Center for Emergency Medicine Informatics website. Available at: http://www.ncemi.org/cse/cse0302.htm . Accessed November 10, 2010.

    Rutka J. Acute otitis externa: treatment perspectives. Ear Nose Throat J . 2004;83(9 Suppl 4):20-21;discussion 21-22.

    US Centers for Disease Control and Prevention. Swimmer’s ear. US Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/healthyswimming/swimmers%5Fear.htm . Accessed September 29, 2005.

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