Key points
Otitis externa - also called otitis of the swimmer - is an inflammatory process affecting the external auditory canal.
Causes
Otitis externa is due to viral (especially herpetic), bacterial and sometimes mycotic infections. More often, otitis externa is a consequence of eczema or purulent otitis media.
Among the factors predisposing to auricular inflammation we mention: diabetes, cold, severe vitamin deficiencies, humidity, dryness of the ear canal.
Symptoms
The characteristic symptoms of otitis externa are: pain during chewing, edema, irritation and redness of the external ear, otalgia, impaired hearing.
therapies
The most indicated therapy depends on the triggering cause: therapeutic aids (to relieve pain), antibiotics (in case of bacterial infection) and antivirals (if the cause of external otitis depends on viral insults).
Otitis externa
External otitis is defined as acute or chronic inflammation that partially or completely involves the external auditory canal. Sometimes the inflammatory process also diffuses on the external surface of the tympanic membrane.
Otitis externa is a typical swimmer disease: not surprisingly, it has also been dubbed as "swimmer's ear infections". The cause of the disease lies mainly in bacterial infections, easily treatable with emollient drops with cerumolytic action, antibiotics / antivirals and possibly corticosteroids.
Causes and risk factors
CAUSES
Otitis externa has an almost exclusively bacterial etiology, although it can sometimes be caused by fungal or viral infections.
The bacteria most involved in the disease are Pseudomonas aeruginosa and Staphylococcus aureus .
RISK FACTORS
Several factors can increase the risk of otitis externa:
- Absence of earwax
- Continuous swimming in the pool: swimmers are prone to the formation of otitis externa as repeated exposure to water, with the subsequent "mechanical" removal of wax, can damage the external auditory canal making the area more susceptible to bacterial attacks. Furthermore, the stagnation of water inside the ear canal can create an environment conducive to the proliferation of bacteria.
- Otitis media: it is not uncommon for swimmer's otitis to be the result of middle ear infections
- High temperature and humidity
- Washing the ear with aggressive detergents: soaps, shampoos and shower gels can enter the ear canal and cause itching. The subject, scratching, can damage the skin, thus creating a possible gateway for pathogens.
- Local traumas: caused by incorrect ear cleaning (eg cleaning with cotton swabs) or using hearing aids.
Classification and symptoms
Depending on the symptoms and causes, multiple forms of otitis externa can be identified:
- Acute external otitis: the most frequent variant ever, caused by bacteria or fungi. The symptoms of acute external otitis appear suddenly, usually within 48 hours of infection. The clinical picture is characterized by:
- Tinnitus (ringing in the ears)
- Bacterial auricular cellulitis (rare)
- Hearing impairment
- Ear edema
- Erythema (irritation, redness), ear and tympanic membrane
- Tenderness to the touch
- Hyperemia (increased blood in the outer ear)
- Hearing loss (hearing reduction)
- Lymphadenitis: inflammation of the lymph nodes
- Otalgia (ear pain)
- Perception of "muffled" sounds
- More or less intense itching
- Sensation of auricular fullness
- Chronic otitis externa: the symptoms of chronic otitis externa are the same as those of the acute form, but last for over 6 weeks.
- Localized external otitis (furunculosis): inflammation of the ear is associated with infections affecting hair follicles.
- Eczematous external otitis: external otitis is caused by extra-infectious factors, such as atopic dermatitis, lupus erythematosus, eczema and psoriasis.
- Necrotizing malignant external otitis: it is a serious infection that, starting from the external ear, spreads to the deeper tissues, adjacent to the ear canal. The malignant necrotizing form of otitis generally affects immunocompromised patients (eg, those suffering from AIDS), diabetics and shortcomings. This form of otitis can cause serious complications, such as:
- Bacterial cellulite
- Osteomyelitis
- Cervical paralysis
- Deafness
- Dizziness
Diagnosis
In some cases, it is necessary to proceed with the analysis of the tympanic membrane, to evaluate possible damage: if this were the case, the patient should go to the otolaryngologist for further tests.
Also the biopsy and culture of a cerumen sample is a diagnostic test used for otitis externa, useful for identifying the pathogen involved in the infection and its response to antibiotics (antibiogram).
Therapy
The goal of treatment for otitis externa is to stop the infection by killing the pathogen involved. First of all, the correct cleaning of the ear canal is essential to remove debris and pathogenic particles deposited in the tympanum basin: in similar situations the cleaning of the ears, carried out by the specialist, consists in removing the earwax through curettage or aspiration.
To stop the infection, specific antibiotics (for bacterial otitis) or antifungals (for fungal forms) are needed. Topical application of corticosteroid drugs can reduce inflammation, while the instillation of specific ceruminolytic drops (a slightly acid solution) can favor the removal of waste and create an environment hostile to the attack of bacteria and other pathogens.
In conclusion, we recall that prevention - consisting in thorough cleaning of the ears - is the most effective weapon against external otitis.
