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 May 11, 2005
Otitis Externa
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Otitis Externa is an inflammation of the ear canal caused by infection with bacteria or fungus.


Otitis externa, or swimmer's ear, usually starts out as a nagging itch, brought on by a softening of the protective lining of the ear canal. However, it can blossom into as painful an infection as you will ever experience. For adults, swimmer's ear is the second most common cause of ear pain after TMJ (temporo-mandibular joint) syndrome. With a few simple preventive measures it can be kept in check, never developing into a full-blown infection. When swimmer's ear is unchecked and advances into an infection, extreme pain, yellowish pus, and even temporary hearing loss can occur. At this point, it must be treated by a physician who will clean out the ear, administer antibiotic eardrops or pain medication, or both.


Swimmer's ear is a problem that affects anyone who spends time in water, lives in a humid environment, or sweats profusely. Water and excessive moisture wash away the ear canal's protective skin and earwax barrier and create a medium for bacterial growth. Contrary to popular belief, swimming in dirty water does not necessarily bring on swimmer's ear. When the skin-and-wax barrier is intact, it repels bacteria. Pool swimmers are particularly at risk because the water-chlorine combination changes ear chemistry from an acidic medium to an alkaline one. Once again, this creates a perfect breeding ground for bacteria and fungus. Surprisingly, using cotton-tip applicators to clean the ears is the leading cause of otitis externa. A few twists with an applicator is all that it takes to rub away the protective skin and earwax in the canal.


The major symptoms are: itching in the ear canal in the early stages; ear pain that may worsen when pulling the earlobe; discharge of pus or fluid from the ear canal; redness and swelling of the skin of the ear canal; a small, painful lump or boil in the ear canal; eczema (patches of broken, flaky, itchy, red, oozing skin); temporary hearing loss due to pus accumulation in the ear canal; and fever.


Before you are treated for otitis externa, be sure to rule out the following conditions that may closely mimic the infection: Eczema (red and scaly skin disease), Folliculitis (inflammation of hair follicles causing a boil), Ramsey Hunt Syndrome (herpes zoster infection of the geniculate ganglion) or Otitis Media.


The best way to combat the itch of swimmer's ear is with strict aural hygiene. Other methods of treatment are:

  • Over-the-counter pain relievers - acetaminophen instead of aspirin for children
  • Use of a small suction device by the doctor to remove excess fluid and pus from the ear canal
  • Topical antibiotics or antifungal eardrops may be prescribed to treat infection, in addition to corticosteroid drops to reduce inflammation
  • Oral antibiotics may be given for severe infection
  • Surgical removal of dead tissue may be required to treat malignant otitis externa
  • Codeine or narcotics may be prescribed to relieve severe pain
After symptoms disappear, avoid getting water into the ear canal for up to three weeks. During this period, protect your ears when showering or washing your hair, and avoid swimming. In the event of a recurrence, keep a supply of the prescription eardrops on hand to ease symptoms.


Use antiseptic eardrops whenever the water is trapped in the ears. Such eardrops are inexpensive and sold without prescription under various trade names such as Aqua Ear, Ear magic or Swim Ear. Or Use rubbing alcohol. It absorbs the water, helps dry our the ear, and may even kill the bacteria and funguses that cause otitis externa. Or Use white vinegar. Mix the vinegar with the rubbing alcohol.


What is the probable cause? What treatment do you suggest? Is there evidence of an infection? Will eardrops help? Will you be recommending corticosteroids to reduce the inflammation? What preventive measures should be taken?

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