Article by Hearing Partners, contributed by Soh Lee Lee, Senior Clinical Audiologist at Hearing Partners
The ear consists of three main parts: the outer ear (which includes the pinna and external ear canal), the middle ear located behind the eardrum, and the inner ear where the cochlea is found. A common condition that affects the outer ear is otitis externa, also known as Swimmer’s Ear or outer ear infection.
Despite its name, otitis externa can affect anyone. It’s a fungal or bacterial infection caused by water trapped in the ear canal. In this article, we’ll explore the symptoms, causes, and treatment options for otitis externa, along with tips for prevention.
Symptoms of Otitis Externa
Otitis externa can manifest through a variety of symptoms, often causing discomfort and irritation. Recognizing them early can help with prompt treatment. Common symptoms include:
- Itching in the ear canal
- Foul-smelling fluid discharge from the ear
- A feeling of fullness or blockage in the ear
- Muffled hearing
- Redness or swelling of the outer ear
- Swollen lymph nodes around your ear
Causes and Risk Factors of Otitis Externa
Otitis externa can arise from various factors that disrupt the ear canal’s natural defences. This section will discuss possible causes and risk factors of otitis externa.
Skin injury
Scratching or cleaning your ear with your fingers or an ear pick can damage the delicate skin in your ear canal. When the skin is damaged, bacteria that normally reside on the surface can cause an infection, leading to otitis externa.
Removal of earwax
Earwax plays a vital role in protecting the ear canal as it has natural anti-bacterial and anti-fungal properties. However, this protective barrier can be compromised due to excessive moisture in the ear or overcleaning. As a result, you may become more susceptible to otitis externa.
Exposure to water
If you enjoy swimming or other water activities, you might be at a greater risk of developing otitis externa because water can wash away too much earwax. Additionally, exposure to contaminated water can introduce bacteria into the ear, leading to an external ear infection.
High humidity
Humid environments can increase the risk of otitis externa, as fungi thrive in moist conditions. Thus, those living in tropical regions tend to be more prone to such ear infections.
Skin conditions
Skin conditions such as eczema or psoriasis can increase the risk of developing otitis externa. These conditions often lead to dryness, irritation, and inflammation in the ear canal, making it more susceptible to infections.
Diabetes
Diabetes can elevate the risk of ear infections due to compromised immune function, which makes it harder for the body to fight infections. Additionally, individuals with diabetes are more susceptible to a severe form of the infection known as malignant otitis externa, where the infection can extend to the skull bone.
Treatment for Otitis Externa
Treating otitis externa typically involves addressing the infection and alleviating symptoms. With appropriate treatment, most cases can be resolved within 7 to 10 days. The following treatment methods are often recommended for otitis externa and work hand-in-hand to tackle the infection and its symptoms.
Aural toilet
Aural toilet, also known as ear cleaning, is a procedure to remove wax and debris from the ear. This procedure is often recommended as the first step in treating otitis externa and is crucial in ensuring the effectiveness of topical antibiotics.
Once wax and debris have been removed from the ear, your hearing care professional can also check the condition of your eardrum and ensure that it’s intact.
Topical antibiotics
Antibiotic ear drops may be used to target bacteria in the ear, thereby eliminating the infection. In some cases, an ear wick, which is a small sponge, may be used to help the antibiotics penetrate deeper into the ear canal. It will be placed in the ear to hold the ear drops against the skin, ensuring more effective treatment.
| Note!
Oral antibiotics are usually only recommended for severe cases. In most instances, topical antibiotics would be the most effective treatment method. |
Analgesics
Doctors may prescribe over-the-counter pain medication, also known as analgesics to alleviate any pain and discomfort associated with the ear infection. This can provide relief while the underlying condition is treated.
Preventing Otitis Externa
Taking preventive measures can significantly reduce the risk of developing otitis externa. These simple habits can keep your ears healthy and protect them from infection.
Avoid cleaning your ears
Your ears have a natural self-cleaning mechanism that effectively manages earwax buildup. Avoid cleaning your ears with Q-tips or even your fingers, as this can disrupt the ear’s natural process, compact ear wax deeper into the ear canal and introduce bacteria to the ear canal. Leaving your ears to clear out wax naturally will help reduce the risk of infections like otitis externa.
Prevent water from entering your ears
To protect your ears during water activities, consider wearing swim plugs or a swimming cap to keep your ears dry. Minimising exposure to moisture and potential contaminants in the water can also lower the risk of developing otitis externa. As such, avoid entering water bodies that are visibly contaminated or poorly maintained.
Keep your ears dry
Keeping your ears dry is essential in preventing ear infections. After water activities, gently dry the outer ear canal with a towel. If water has entered your ear, tilting your head toward the affected side can help facilitate drainage.
When to See a Doctor
If you notice any of the following signs, seek medical attention from an Ear, Nose and Throat (ENT) doctor immediately:
- Persistent ear pain that worsens over time
- Foul-smelling discharge from the ear
- Significant swelling or redness around the ear
- Hearing loss or a feeling of fullness in the ear that doesn’t improve
- Fever accompanying ear symptoms
FAQs About Otitis Externa
What is the difference between otitis externa and otitis media?
| Otitis Externa | Otitis Media | |
| Affected part of the ear | Ear canal | Middle ear |
| Causes | Bacteria or fungi | Bacteria or virus |
| Treatment | Treatment is necessary for recovery.
Antibiotic or corticosteroid ear drops are typically prescribed. Depending on your condition, pain medication may also be prescribed. |
Typically resolves naturally. If treatment is necessary, the following may be prescribed:
● Over-the-counter pain medication ● Antibiotics for bacteria infection ● Tympanostomy (a small tube inserted into the eardrum) to drain fluid from the middle ear |
What is malignant otitis externa?
Malignant otitis externa is a severe infection of the outer ear and ear canal that can extend to surrounding structures, including the skull bone. Despite the term “malignant,” this condition is not cancerous. Rather, it’s a serious infection often associated with complications.
Individuals with diabetes or weakened immune systems are particularly susceptible to developing malignant otitis externa. The symptoms include:
- Severe ear pain, often worsening at night
- Foul-smelling discharge from the ear
- Pus and debris in the ear canal
- Decreased hearing
- Potential paralysis of facial and head nerves
How is otitis externa diagnosed?
To diagnose otitis externa, the doctor will begin by taking your medical history and conducting a physical examination of the ear. During the examination, the doctor will look for signs such as redness, swelling, and drainage from the ear canal.
Additionally, they may use an otoscope to check if the infection has spread and the condition of the eardrum. If necessary, a sample of ear drainage may also be cultured to determine the appropriate treatment.
Will otitis externa go away by itself?
Otitis externa typically will not resolve on its own, and treatment is necessary for recovery. Most people can expect to see improvement within 7 to 10 days after undergoing treatment.
Can I leave otitis externa untreated?
Untreated otitis externa can lead to several complications. Possible consequences include:
- Increased pain and discomfort
- Development of a more severe infection, such as malignant otitis externa
- Spread of the infection to the base of the skull, brain, or cranial nerves
- Temporary or permanent hearing loss
Take Charge of Your Hearing Health
Otitis externa is a preventable and treatable condition that affects the outer ear canal. Recognizing symptoms early and seeking appropriate treatment is important for recovery within a short period. Additionally, preventive steps like keeping ears dry and avoiding excessive cleaning can lower the risk of infection. If symptoms persist or worsen, it’s important to seek medical attention to prevent further complications.
