Otitis Externa

otitis externa

This condition involves inflammation of the external part of the ear including the outer ear and the ear canal.

Cause

Otitis externa is usually a multifactorial issue, where integrity of the ear skin combines with local trauma and then leads onto infection.

Diagnosis

Usual symptoms include pain, swelling of the external ear and canal, and discharge from the ear. Pain can be severe for many patients. Symptoms can be associated with water exposure, such as swimming. Some patients report underlying conditions which affect functioning of the ear such as diabetes or eczema.

The ear can be tender or itchy to examine. Swelling of the ear canal is typically seen when the ear is examined with a microscope. Sloughy discharge can usually be seen.

Swabs are normally taken to guide further treatment. When initial ear drops are not effective, it may be that atypical bacteria or fungus is present. Ear swabs help determine which drops will be effective.

Treatment

Treatment for otitis externa can be divided into short and long term. The goal is to address the immediate infection, but also to manage the integrity of the skin. Some patients have flare ups from time to time and need treatment for this, but might be maintained on a medication regime in the long term. Short term treatment involves strict water proofing (try Vaseline and cotton wool, blu-tak or silicon ear plugs when showering). Avoid putting anything in your ear to itch it or clear debris as this can traumatize the delicate healing skin. Antibiotic drops are much more effective than oral liquid or tablet medications as the drops act directly at the site of contact. The most effective way to use these is to lie on your side and have a family member carefully drip several drops into the canal. These can be massaged down by gentle pushing on the cartilage at the front of the ear. Lie on your side for 10 minutes before getting up. It is usual to use drops at least twice a day and often for several days in a row. Ear suctioning using the microscope clears out debris and allows me to check progress of the ear. Once the immediate issues resolve, some patients go on to a regime where drops might be used for a few days each month to prevent inflammation recurring. I’ll usually recommend a regime that starts on the first of the month so that as the calendar rolls over, it’s easier to remember to start your treatment.