From the Guidelines
Otitis externa, or swimmer's ear, is an infection of the ear canal typically caused by water remaining in the ear after swimming, creating a moist environment where bacteria or fungi can grow, as defined by the clinical practice guideline published in 2014 by the American Academy of Otolaryngology-Head and Neck Surgery Foundation 1.
Definition and Causes
Otitis externa is characterized by diffuse inflammation of the external ear canal, which may also involve the pinna or tympanic membrane, with symptoms including ear pain, itching, redness, swelling, and sometimes discharge or temporary hearing loss. The most common pathogens are Pseudomonas aeruginosa and Staphylococcus aureus, often occurring as a polymicrobial infection, as stated in the clinical practice guideline 1.
Diagnosis and Treatment
Diagnosis of diffuse otitis externa requires rapid onset of symptoms and signs of ear canal inflammation, with a hallmark sign being tenderness of the tragus, pinna, or both. Treatment usually involves antibiotic ear drops like ciprofloxacin or neomycin/polymyxin B, used 3-4 times daily for 7-10 days, as well as pain relief with over-the-counter medications like acetaminophen or ibuprofen. It is essential to keep the ear dry during treatment by avoiding swimming and using earplugs during showers.
Prevention and Special Considerations
Prevention methods include drying ears thoroughly after swimming by tilting your head to each side, using a hair dryer on low setting, or using over-the-counter drying drops containing alcohol. Patients with diabetes, an immunocompromised state, or both require special consideration, as they are susceptible to otomycosis and necrotizing otitis externa, which may present similar to otitis externa but require different management, as discussed in the clinical practice guideline 1.
Key Points
- Otitis externa is an infection of the ear canal caused by bacteria or fungi
- Symptoms include ear pain, itching, redness, swelling, and sometimes discharge or temporary hearing loss
- Treatment involves antibiotic ear drops and pain relief with over-the-counter medications
- Prevention methods include drying ears thoroughly after swimming and using earplugs during showers
- Patients with diabetes or an immunocompromised state require special consideration due to the risk of complications such as otomycosis and necrotizing otitis externa, as highlighted in the clinical practice guideline 1 and the practice guidelines for diseases caused by Aspergillus 1.
From the FDA Drug Label
An ear canal infection (also known as “Swimmer’s Ear”) is a bacterial infection of the ear canal. The ear canal and the outer part of the ear may swell, turn red, and be painful Also, a fluid discharge may appear in the ear canal.
Otitis externa (swimmer's ear) is a bacterial infection of the ear canal, characterized by swelling, redness, pain, and possible fluid discharge in the ear canal 2.
From the Research
Definition and Causes of Otitis Externa
- Otitis externa, also known as swimmer's ear, is a common and often painful infection in the ear canal 3, 4, 5, 6, 7.
- The condition is influenced by factors like pH levels, inflammation, and bacterial or fungal invasion, with the most common bacteria involved being Pseudomonas aeruginosa and Staphylococcus aureus, and the most common fungi being Aspergillus and Candida species 3.
- Swimming is a major risk factor associated with the disease, in addition to the most common pathogenic organisms 5.
Symptoms and Complications
- Symptoms of otitis externa include ear discomfort, itchiness, discharge, and impaired hearing 4, 6, 7.
- The condition can lead to serious complications, such as necrotising otitis externa, which requires prompt medical attention 3.
- Other complications include exostoses, traumatic eardrum perforation, middle ear infection, and barotraumas of the inner ear 4.
Treatment and Management
- Treatment involves local care, ear drops, and, in severe cases, systemic antibiotics 3, 4, 5, 6, 7.
- Topical antimicrobials containing steroids are significantly more effective than placebo drops 7.
- The choice of topical intervention does not appear to influence the therapeutic outcome significantly, and any observed differences in efficacy are usually minor and not consistently present at each follow-up visit 7.
- Oral antibiotics are effective only in cases with severe oedema and higher grades of otitis externa, and their use should be considered cautiously in this antibiotic resistance era 6.