What is Otitis Externa (OE)?
Otitis Externa means inflammation/ infection of the EAR CANAL.
This is usually due to moistness/water entering the ear canal of a susceptible person. The water softens the skin of the ear canal and this may become infected. (Usually the water runs back out, the ear dries out and the bacteria and fungi don't cause any problems.)
These bacteria and fungi reside on the surface of the healthy skin throughout the body, and it is only when one of these bugs invades damaged skin does infection set in. Water elevates the Ph level of the canal.
Another common cause of otitis externa is trauma to the ear canal-by cotton buds, hair clips, fingernails, matchsticks, and car keys - all used to scratch the ear!
There may also be a localised inflammation, due to a boil in the upper third of the canal, usually associated with a hair follicle. Sometimes skin conditions such as dermatitis, psoriasis, may also affect the skin of the canal. Chronic otitis externa can occur secondarily to active chronic otitis media, (middle ear infection.) Uncommonly, a reaction to certain eardrops is the cause.
In the case of fungal otitis externa, sometimes the fungus may live on the surface of a hearing aid mould, which results in a relapse of the condition following apparent successful treatment.
Herpes Zoster Oticus (Shingles) can infect the ear canal, but is quite rare. Usually the person is seriously ill and hospitalised.
Common Symptoms of Otitis Externa
Itchiness, pain, discharge - thin and milky, hearing loss, blocked feeling.
What else may happen?
The infection may spread; the ear canal may swell and close off. Severe cases may turn into cellullitis and require hospital admission for IV antibiotic therapy and daily aural toilet (ear cleaning)
The area in front or behind the ear may become red, sore and swollen and a glandular lump may appear high in the neck. The person may feel unwell, with fever, malaise, nausea and lethargy.
How is it treated?
If it is a minor infection, a visit to your GP and the prescription of ear drops alone may clear it fairly quickly. However, it is suggested to keep water out of the ear, especially when using shampoo for hair washing. Do not use cotton buds.
Antibiotic and steroid eardrops (usually combined in the one product) should be used three times per day and at least 5 - 6 drops each time. It is pointless to install eardrops into an ear canal filled with debris, as the medication will not be effective unless it makes direct contact with the skin. It is also advisable to visit your doctor after using the medication for seven days to ensure the infection is resolving. If the infection has worsened, an ear swab is advised, as certain bacteria and fungi may be isolated from a swab and appropriate eardrops prescribed.
If there is a large amount of debris, the ear canal is best cleaned by suction under direct vision with a microscope. Ask your doctor for an immediate referral an Ear Clinic . This ear cleaning is usually carried out on a regular basis until the infection has cleared. It is important to keep the ear clean and dry.
Ear syringing can result in worsening of the condition as water encourages bacteria to grow. The most common cause of failed treatment is getting the ear wet. The entire sequence of events of Otitis Externa can easily be prevented if one uses antiseptic eardrops whenever water is thought to be trapped in the ear, e.g. Vosol or White vinegar and water.