Can you get otitis media and otitis externa (swimmer's ear) at the same time?

Concurrent Otitis Media and Otitis Externa

Yes, it is possible to have both otitis media and otitis externa (swimmer's ear) infections simultaneously, as they affect different parts of the ear and have distinct pathophysiologies. 1, 2

Anatomical and Pathophysiological Basis

• Distinct anatomical locations:

  • Otitis externa affects the external auditory canal (EAC) and sometimes the pinna 1
  • Otitis media affects the middle ear space behind the tympanic membrane 1

• Different causative organisms:

  • Otitis externa: Primarily Pseudomonas aeruginosa and Staphylococcus aureus 1, 2
  • Otitis media: Primarily Streptococcus pneumoniae and Haemophilus influenzae 1

Diagnostic Considerations for Concurrent Infections

When evaluating a patient with ear pain, consider these distinguishing features:

• Otitis Externa signs/symptoms:

  • Tragal tenderness (hallmark sign)
  • Ear canal edema and erythema
  • Discharge in the ear canal
  • Itchiness 1

• Otitis Media signs/symptoms:

  • Bulging tympanic membrane
  • Reduced tympanic membrane mobility
  • Conductive hearing loss
  • Fever (especially in children) 1

Important caveat: Otitis externa can sometimes mimic the appearance of acute otitis media due to erythema involving the tympanic membrane 1, making careful examination crucial for accurate diagnosis.

Treatment Approach for Concurrent Infections

When both conditions are present simultaneously, treatment must address both infections:

1. For Otitis Externa:

• First-line therapy: Topical antibiotic preparations (fluoroquinolone eardrops)

  • Clinical cure rates of 77-96% 2
  • Typical duration: 7 days

• Administration technique:

  • Clean ear canal of debris before administration
  • Maintain proper position after instillation
  • "Pump" the tragus several times to aid delivery 1, 2

2. For Otitis Media:

• Treatment approach:

  • Oral antibiotics (typically amoxicillin) for bacterial AOM
  • Consider tympanostomy tubes for recurrent or chronic cases 1

• Special consideration: If tympanostomy tubes are present with discharge (acute TTO):

  • Use only topical antibiotics approved for use with tympanostomy tubes
  • Avoid aminoglycoside-containing eardrops due to potential ototoxicity 1

3. Pain Management for Both Conditions:

• Acetaminophen or NSAIDs for immediate pain relief 2

Important Clinical Pitfalls

1. Misdiagnosis risk: External otitis can sometimes be mistaken for otitis media due to erythema extending to the tympanic membrane 1

2. Treatment complications: Using aminoglycoside-containing eardrops (common for otitis externa) in patients with perforated tympanic membranes or tympanostomy tubes can cause ototoxicity 1

3. Monitoring for complications: Watch for signs of spreading infection beyond the ear canal, which would require systemic antibiotics 2

4. Necrotizing otitis externa risk: Patients with diabetes or immunosuppression require close monitoring as otitis externa can progress to this serious condition 1, 2

By recognizing that these conditions can coexist and implementing appropriate treatment strategies for each, clinicians can effectively manage both infections simultaneously and prevent complications.