Otitis Externa is an infection in the ear canal, the external part of the ear. It is the second most common ear infection, following Otitis Media, which affects the middle ear. Bacteria, fungi, or both can cause the infection and in rare cases, viruses may also be involved.
Types
Otitis Externa is a broad term encompassing various external ear canal infections, most commonly caused by bacteria or fungi. Viral infections are rare in this condition, while bacterial and fungal infections are much more common. In some cases, both bacterial and fungal infections may coexist, making it important to tailor treatments to the specific type of infection.
Otitis Externa can be broadly classified into:
Circumscribed Otitis Externa: This localized infection affects a small area of the external ear canal, often leading to boils or furuncles. Staphylococcus aureus bacteria usually cause it.
Diffuse Otitis Externa: This infection spreads across a larger portion of the ear canal. There are various subtypes under diffuse otitis externa, each with distinct causes and characteristics.
Bacterial Otitis Externa
Fungal Otitis Externa – Otomycosis
Diffuse Chronic Otitis Externa - Swimmer’s Ear
Malignant Otitis Externa
Myringitis Bullosa can occur in the ear canal and affects the eardrum, primarily caused by viruses and sometimes bacteria. It may sometimes spread to the middle ear.
Causes
Cleaning with external objects: Using objects to clean ears can lead to bacterial and fungal diffuse otitis externa.
Cleaning wet ears: Fragile, wet skin increases the risk of more severe infections.
Unhygienic tools: Using dirty objects for ear cleaning raises the chances of bacterial and fungal infections.
Humid environments: Humidity encourages fungal growth in the ear canal.
Swimming: Regular swimmers risk chronic otitis externa from continuous exposure to water and chemicals.
Staphylococcus Aureus: This bacteria can cause boils in ear canal follicles, leading to circumscribed otitis externa.
Viruses: Bullous Myringitis Haemorrhagica is a rare, painful ear infection caused by viruses.
Symptoms
Ear Pain:
Itchiness followed by pain: Seen in Otomycosis (fungal ear infection).
Tender ear pinna: Pain when touching the ear can indicate a bacterial infection.
Circumscribed otitis externa: Pain in one quadrant of the ear pinna.
Diffuse otitis externa: Pain when touching any part of the ear pinna.
Severe pain:
Localized pain: Indicates circumscribed otitis externa (boil in the outer ear).
Pain beyond the ear: May suggest malignant otitis externa.
Severe pain can also result from bullous myringitis.
Itchiness in the ear: Persistent itching is a sign of a fungal infection in the ear canal.
Ear Discharge:
Eardrum perforation: Discharge can indicate a perforated eardrum due to untreated infections or harmful home remedies.
Blood-colored watery discharge: A sign of Bullous Myringitis Haemorrhagica.
Deafness and ear block sensation: Can indicate otitis externa or other ear infections.
Redness and swelling: These are signs of diffuse otitis externa.
Boil in the ear: Boil with localized pain suggests circumscribed otitis externa, and boils may also appear on the face.
Diagnosis
Diagnosing ear issues requires expertise as the ear is a complex organ. Most external ear infections can be easily identified using an otoscope or diagnostic endoscope. While the process may seem straightforward, interpreting the symptoms and findings, especially in rare cases like bullous myringitis, demands experience and specialized knowledge.
Treatment
Treatment for ear infections including external ear infections varies by diagnosis. While multiple conditions can occur simultaneously, here’s a general guide, but always consult an ENT for appropriate diagnosis and treatment:
Bacterial Diffuse Otitis Externa: Oral antibiotics, ear drops, or ointments.
Fungal Otitis Externa (Otomycosis): Requires fungal clean-up by an ENT, followed by antifungal ear drops.
Circumscribed Otitis Externa: Antibiotics like Amoxicillin or Co-Amoxiclav targeting staphylococcal bacteria.
Swimmer’s Ear: Can be fungal, bacterial, or both; treated with oral antibiotics and cream containing antibiotics, antifungals, and a mild steroid.
Bullous Myringitis Haemorrhagica: High doses of oral antibiotics.
Malignant Otitis Externa: Surgery and potent antibiotics.
Prevention
Prevent water from entering the ear: Use earplugs during swimming or other water activities.
Avoid cleaning wet ears: Do not clean the ears after water exposure, as it can damage the skin and protective layer.
Avoid inserting objects: Refrain from using cotton swabs or fingers in the ear canal to avoid damaging the skin.
Seek prompt treatment: Consult a doctor at the first sign of otitis externa to avoid complications.
Do not use oil drops: Oil can promote fungal growth; consult an ENT for safe treatment options for dry ears.
Prevent furuncle otitis externa: Consult a dermatologist to manage Staphylococcus carrier status, practice good hygiene, and address skin infections early, especially in hot and humid environments.
Complications
Complications can arise if otitis externa is left untreated:
Spread of Infection: In severe cases, the infection can extend beyond the ear canal to nearby structures like the temporomandibular joint, temporal bone, parotid gland, or even the coverings of the brain, leading to more serious and potentially life-threatening conditions.
Eardrum Perforation: Prolonged diffuse otitis externa may cause eardrum perforation, resulting in hearing loss and increased vulnerability to further infections.
Home Remedies
For proper treatment of Otitis Externa or Ear Canal infection, getting an accurate diagnosis is essential. It's best to consult a doctor for appropriate medical treatment and safe home remedies. Traditional home remedies often cause more harm than good, and over-the-counter or self-medication should be avoided.
Summary
Always consult an ENT for external ear canal issues, as there can be multiple possible diagnoses. In this article alone, we have discussed six different types of infections, including subtypes. Each condition requires specific treatment, and multiple infections can coexist. To prevent complications, it is important to seek expert advice from an ENT to properly address the infection.
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