Otitis externa (OE) is a type of ear infection – an infection of the ear canal, sometimes called ‘swimmer’s ear’. Because the canal is dark and warm, it can easily get infected with bacteria and fungus. Usually the entire canal is involved, but a external auditory canal furuncle can be considered a localized form of OE. Diffuse OE is typically a bacterial infection, the most common pathogens being Pseudomonas, Staphylococci, and Proteus, but fungi may also be involved (most commonly Aspergillus and Candida). OE can spread to affect surrounding tissues. OE is different from the kind of infection you get in the middle part of your ear. That kind of infection is called otitis media.
Several things can make OE more likely, including the following:
- If you swim or shower a lot, too much water can get into your ears, removing the protective ear wax or remaining in the canal. The water may introduce organisms and makes it easier for germs and fungus to grow in the moist environment.
- Cleaning your ears can remove the protective wax layer and lead to infection.
- If you injure the skin in the ear canal by putting your finger or some object in your ear, an infection can develop in the canal.
- Skin conditions such as psoriasis that occur in other parts of the body can also occur in the ear canal and cause OE.
Your ear might itch, or even hurt very badly. The pain might get worse when your ear moves while you’re chewing. The ear might feel plugged up. You might not be able to hear as well. Your ears might drain. See your doctor if any of these things happen. None of these things should last if you get treated.
Your doctor will inspect your ear and remove any drainage, pus and possibly wax. They will also make sure that the infection is not deeper. Most OE infections can be treated with ear drops, but sometimes pills are needed.
Your doctor will tell you how, how long and how often to use your ear drops. Warm the bottle in your hands before putting the drops in your ear. Using warm ear drops may keep you from getting dizzy when the drops go in. Sometimes cotton is inserted afterwards to hold the medication in.
While OE can be hard to treat, there are things you can do to help, as well as prevent recurrence.
- Keep your ear as dry as possible for 7 to 10 days. Take baths instead of showers. Try to keep water out of your ears when you wash your hair. Don’t swim or play other water sports. If you’re on a swim team, ask your doctor before you return to swimming.
- Don’t put anything except the prescribed medicine in your ears. Scratching and rubbing will only make OE worse.
- Never put anything in the ear canal (cotton swabs, paper clips, liquids or sprays, or even your finger). This can damage or irritate the skin. If your ears itch a lot, see your doctor. Don’t use earplugs. They can irritate the ear canal.
- Leave ear wax alone. If you think your ear wax affects your hearing, see your doctor to be sure there’s no other cause.
- Keep your ears as dry as possible. Use a towel to dry your ears well after swimming or showering. Help the water run out of your ears by turning your head to each side and pulling the earlobe in different directions. A hair dryer set on the lowest heat and speed can also help to dry ears. Be sure to hold it several inches from your ear. If you swim or surf, use a bathing cap or wet suit hood to keep water out of your ears.
Symptoms are usually much better in 3 days and should be completely gone in 10 days. If you’re not better by then, see your doctor.
Conventional therapy may consist of combination antibiotic/steroid drops. Sometimes a wick is placed in the canal. The ear wick is typically a dried sponge which is inserted into the canal. It helps wick ear drops along the canal, holds the solution in contact with the skin of the canal, and also applies pressure to the canal skin. Wicks are removed at 2 days, and can be replaced then if necessary.
Risk factors for Ear infection, External
History of ear canal infections
Recommendations for Ear infection, External
Garlic
Garlic has been used since ancient times to treat a wide variety of conditions. Garlic is useful in the treatment of ear infections because it has demonstrated significant broad-spectrum anti-microbial and anti-inflammatory activity. Mullein-Garlic ear drops can be used at room temperature or warmed under the faucet. Place 3 drops in the affected ear three times daily.
Mullein is an herb that is used specifically for ear infections. It is prepared in the form of Mullein oil and is used as ear drops. Mullein, also known as Verbascum thapsus, is useful in cases of earaches, as well as dry, scaly conditions in the outer ear.
Vinegar
For prevention purposes only, you can make your own eardrops by mixing equal parts white vinegar and rubbing (isopropyl) alcohol. The vinegar restores the natural acidity of the ear canal, making it less susceptible to infection while the alcohol dries out the ear. Use 3 – 4 drops in each ear after swimming.
Ozone / Oxidative Therapy
A therapeutic test was made with all patients who came to the external consult or to the medical guard with otitis externa. The treatment with ozonized oil was applied regardless of type of germ and symptomatology, and results compared with the habitually used treatments for this purpose. Treatment with ozonated oil was effective. [L.Arias, R.Jimènez, P.Beauballet y S.Menèndez Instituto Superior de Medicina Militar ” Dr.Luis Diaz Soto “, Centro Nacional de Investigaciones Cientificas]
Hydrotherapy
Using moist heat (but not overly hot) can improve circulation and lymph flow when dealing with an external ear infection.
Key
| Strong or generally accepted link |
| May do some good |
| Likely to help |
Glossary
Otitis Externa
Also called Swimmer’s Ear, this is an infection of the outer ear canal caused by either fungus or bacteria. Water that remains trapped in the ear canal (when swimming, for example) can provide a breeding ground for these bacteria and fungi. Symptoms include redness of the outer ear; itching in the ear; pain, especially when touching or wiggling the earlobe; drainage from the ear; swollen glands in the neck; a swollen ear canal; hearing loss.
Bacteria
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Candidiasis
Infection of the skin or mucous membrane with any species of candida, usually Candida albicans. The infection is usually localized to the skin, nails, mouth, vagina, bronchi, or lungs, but may invade the bloodstream. It is a common inhabitant of the GI tract, only becoming a problem when it multiplies excessively and invades local tissues. Growth is encouraged by a weakened immune system, as in AIDS, or with the prolonged administration of antibiotics. Vaginal symptoms include itching in the genital area, pain when urinating, and a thick odorless vaginal discharge.
Otitis Media
A very common condition involving inflammation of the middle ear and can be classified as either acute otitis media (AOM), or otitis media with effusion (OME) which is a chronic disease. It most commonly affects infants and young children but can affect all age groups. Symptoms of AOM include earache, decreased hearing, fever, unsteadiness, and occasionally liquid discharge if the eardrum bursts. Symptoms of OME include decreased hearing, tinnitus and unsteadiness, but OME can be entirely without symptoms. Effusions (discharges) continue for several weeks after AOM; only 60% of ears with AOM are clear at 2 weeks and 80% are clear by 8 weeks.
Psoriasis
An inherited skin disorder in which there are red patches with thick, dry silvery scales. It is caused by the body making too-many skin cells. Sores may be anywhere on the body but are more common on the arms, scalp, ears, and the pubic area. A swelling of small joints may go along with the skin disease.
Steroid
Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.