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Otitis externa is an inflammatory process of the external ear canal, usually by bacteria and occasionally by fungus. It is commonly known as the “swimmer’s ear “
The external ear canal is warm, dark and prone to becoming moist - making it an excellent environment for bacterial and fungal growth. The skin is very thin and therefore the canal is easily traumatised.
Some of the common triggers to getting an infection of the external ear includes
- increased moisture due to swimming, perspiration and high humidity
- insertion of foreign objects such as fingernails, cotton swabs, hearing aids and ear plugs
- trauma to ear canal due to scratching and excessive removal of ear wax
- in some cases, due to pre-existing skin condition like eczema, psoriasis and seborrheic dermatitis that can impair the skin’s protective mechanism
Some simple tips to prevent this from happening includes
- avoiding the use of cotton buds, cotton tip or earwax spoon to clean your ear wax as the ear has its own natural mechanism to remove the ear wax
- if you swim regularly, it is important to ensure your ears are dried after a swim
- you can dry your ear after a swim or after a bath using a hair dryer on the lowest heat setting
The two most characteristic symptoms of otitis externa are
- ear discomfort in the form of pain and/or itching
- and external ear discharge
The ear discomfort can range from itchiness to severe pain that is exacerbated by motion of the ear, including chewing. Pain when touching or wiggling the ear lobe.
Sometimes the patient can also complain of ear fullness and loss of hearing.
When you have the above symptoms, do seek medical attention. Doctors can make a diagnosis through your history and an ear examination using an instrument known as the otoscope.
Treatment of otitis externa involves a few steps.
Firstly, if there are excessive debris or ear wax that may impair healing and absorption of medications, they need to be removed via ear toilet or suctioning.
Do take note that in the acute stage of external ear infection, flushing of the ear is not recommended as it may cause damage to your eardrum.
Secondly, ear drops which may contain antibiotics or steroids or a combination of both are often given to reduce Infection and inflammation.
Occasionally, ear wicks may be inserted to allow the topical antibiotics to reach the deeper part of the ear canal.
In the event the infection Is persistent despite topical ear drops, oral antibiotics may occasionally be used.
Concomitant Middle Ear Infection
Sometimes, concomitant middle ear infection may also occur.
We have to suspect that if
- patient is having a high fever
- if the ear pain is severe
- if there is lymph node enlargement around the ears or at the neck
- or if the patient is also having an upper respiratory tract infection
- and if patient is younger than 2 years old.
By : Dr Chen Yiming
Family Physician, MBBS (Singapore), GDFM (NUS), GDFP Dermatology (NUS)