Otitis externa: what it is, symptoms and causes of inflammation

Pain or itching in the external auditory canal may be a sign of otitis externa — inflammation of the skin of this canal and the auricle. The condition occurs in all age groups but follows a different course in each. Below are the causes, symptoms and the boundaries beyond which a doctor is needed.

What otitis externa is

Otitis externa is inflammation, irritation or infection of the outer ear and ear canal. Colloquially it is called "swimmer's ear" because water is often the trigger.

A distinction is made between acute and chronic processes. Otitis is considered chronic when the disease lasts longer than 4 weeks or causes more than 4 relapses within a year.

Acute otitis externa affects 4 people out of 1000 each year, and the chronic form affects 3–5% of the population. The peak incidence occurs in children aged 7–12 years; men and women are affected equally often.

Causes of inflammation of the outer ear

The ear canal is protected by earwax: it maintains an acidic environment and contains lysozymes. Both a lack and an excess of it are harmful — in either case it is easier for bacteria to establish themselves.

Water, especially contaminated water, provokes inflammation: it dilutes the secretion and creates a moist environment. Therefore otitis of the outer ear occurs more often in swimmers, divers and water-sport enthusiasts, as well as in hot humid climates.

The second cause is trauma to the skin of the canal from cotton swabs, matches or foreign objects. Bacteria penetrate inside through damaged skin.

Non-infectious forms are associated with eczema, seborrhea, neurodermatitis, contact dermatitis from hearing aids or earrings, and allergy to topical products.

The main causative agent is Pseudomonas aeruginosa, isolated in 38% of cases. Fungal infections occur in less than 10% of cases and are classified as a separate group — otomycosis.

Circumscribed otitis manifests as a furuncle of the cartilaginous portion of the canal. Its main causative agent is considered to be Staphylococcus aureus.

Symptoms of otitis externa

The leading sign is ear pain ranging from mild to severe that persists for several days. A distinctive feature: the pain intensifies if the auricle is pulled or the tragus is pressed.

Swelling narrows the lumen of the canal, so sound arrives muffled — as if from a muted trumpet. Congestion, noise or ringing in the ear are added to the pain.

Other signs:

• itching and irritation in and around the canal;
• discharge — yellow, yellow-green, purulent or with an unpleasant odor;
• hearing loss;
• peeling of the ear skin;
• occasionally fever.

Ear dermatitis and otitis externa: what the difference is

Non-infectious otitis externa is associated with skin processes: eczema, seborrhea, neurodermatitis, contact dermatitis — for example, from using hearing aids or earrings — as well as allergy to topical medications.

Constant cleaning of the canal with cotton swabs maintains a chronic process: the protective layer of wax is removed, the skin is traumatized, itching appears, and the inflammatory response is reduced.

How it is diagnosed

The doctor examines the ear with an otoscope — a device with a lamp and a magnifying glass. In otitis externa the walls of the canal are red and swollen, the skin peels, and the tympanic membrane is poorly visible due to swelling.

Touching and moving the auricle intensifies the pain — this is checked during the examination. If necessary, a sample of fluid from the ear is taken and sent to the laboratory to look for bacteria or fungus.

Complications and when to see a doctor

Usually the inflammation remains within the canal. But the infection can spread to surrounding tissues — up to cellulitis of the face or neck and lymphadenitis.

The most severe complication is osteomyelitis of the temporal bone; without treatment, mortality in this condition is about 50%. It is classified as malignant, or necrotizing, otitis externa.

This form occurs in people with diabetes, immunodeficiency, after chemotherapy, taking immunosuppressants or radiotherapy to the skull base area. In them, ear pain requires medical assessment without delay.

An appointment with a doctor is needed if the pain does not subside within 3 days, if otitis recurs, and in a child under 12 months — at the first suspicion. An urgent medical examination is needed for discharge from the ear, very high fever with chills, swelling around the ear, pain and redness of the scalp behind the auricle, vomiting, severe dizziness, new hearing loss and general deterioration of well-being, as well as in diabetes or weakened immunity.

Inflammation of the outer ear by itself is not a reason to call an ambulance; 103 or 112 — only in a life-threatening condition: sudden deterioration, loss of consciousness, difficulty breathing.

The material is for reference and does not replace a doctor's consultation: only a specialist during an examination can assess the ear canal and make a diagnosis.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer