From the Guidelines
Otitis externa symptoms typically include ear pain, itching, fullness, and decreased hearing, and can be effectively managed with topical therapy, such as eardrops, which are the most effective treatment and may contain antibiotics, antiseptics, steroids, or a combination. The symptoms of otitis externa can vary in severity, but most people feel better within 48 to 72 hours of starting treatment and have minimal or no symptoms by 7 days 1. It is essential to note that oral antibiotics are not typically necessary for the treatment of otitis externa, unless the infection has spread beyond the ear canal or the patient has a weakened immune system 1.
Key Symptoms
- Ear pain (otalgia) that worsens when pulling on the outer ear or pressing on the tragus
- Itching inside the ear canal
- Feeling of fullness or blockage
- Decreased hearing
- Drainage from the ear, which may be clear, yellow, or sometimes bloody
- Redness and swelling of the outer ear
- Moist, swollen ear canal skin with debris or discharge
Treatment and Management
- Topical therapy, such as eardrops, is the most effective treatment for otitis externa 1
- Eardrops may contain antibiotics, antiseptics, steroids, or a combination
- Oral antibiotics are not typically necessary, unless the infection has spread beyond the ear canal or the patient has a weakened immune system 1
- Pain medicine may be necessary for relief in the first few days of treatment 1
- It is essential to avoid scratching or touching the ear and to not insert anything into the ear canal, including cotton-tipped swabs, to prevent further irritation and infection 1
Potential Complications
- Necrotizing otitis externa, a severe infection that can occur in patients with diabetes or weakened immune systems 1
- Otomycosis, a fungal infection of the external ear canal, which can occur in patients with diabetes or weakened immune systems 1
- Allergic contact dermatitis, which can occur in response to topical antimicrobial otic preparations 1
From the Research
Otitis Externa Symptoms
- Ear discomfort
- Itchiness
- Discharge
- Impaired hearing 2
- Pain (otalgia)
- Redness
- Swelling of the canal
- Tenderness on movement of the pinna or tragus 3
Common Causes
- Bacterial infection, with primary bacterial infections being Pseudomonas aeruginosa and Staphylococcus aureus 3
Treatment Options
- Topical antimicrobials containing steroids
- Topical antibiotics, such as acetic acid 2%, aminoglycosides, polymyxin B, and quinolones with and without corticosteroids 2, 3
- Oral antibiotics, indicated only if evidence of cellulitis occurs outside of the ear canal or if associated conditions such as immunocompromise, diabetes mellitus, or conditions that would not allow for the use of topical treatment are found 3
- Analgesics for pain relief 3
Prevention
- Avoiding injury to the ear canal
- Keeping the ear canal free of water 3