Otitis Externa Health Article

When to call the doctor

The doctor should be called if any of the following symptoms are present:

• pain in an ear with or without fever
• persistent itching of the ear or in the ear canal
• loss of hearing or decreased hearing in one or both ears
• discharge from an ear, especially if it is thick, discolored, bloody, or foul-smelling

Diagnosis

Diagnosis of uncomplicated otitis externa is usually quite simple. The symptoms alone, of ear pain worsened by any touch to the outer ear, are characteristic of otitis externa. Examination of the ear canal will usually reveal redness and swelling. It may be impossible (due to pain and swelling) to see much of the ear canal, but this inability itself is diagnostic.

If there is a need to identify the types of organisms causing otitis externa, the canal can be gently swabbed to obtain a specimen. The organisms present in the specimen can then be cultured (allowed to multiply) in a laboratory, and then viewed under a microscope to allow identification of the causative organisms.

If the rare infection malignant otitis externa is suspected, computed tomography scan (CT scan) or magnetic resonance imaging (MRI) scans will be performed to determine how widely the infection has spread within bone and tissue. A swab of the external canal will not necessarily reveal the actual causative organism, so some other tissue sample (biopsy) will need to be obtained. The CT or MRI will help the doctor decide where the most severe focus of infection is located, in order to guide the choice of a biopsy site.

Treatment

Otitis externa us usually not a dangerous condition and often clears up by itself within a few days. To aid in the healing, the infected ear canal can be washed with an over-the-counter topical antiseptic. Pain can be relieved be placing a warm heating pad or compress on the infected ear as well as through the use of an over-thecounter pain reliever such as acetaminophen or aspirin. During the healing process, the infected ear canal must be kept dry, even while showering, through the use of ear plugs or a shower cap.

If the pain worsens or does not improve within 24 hours, or for the fastest way to relieve pain and to prevent the spread of infection, the doctor should be seen. The doctor will clean the ear with a suction-tipped probe or other type of suction device to relieve irritation and pain. Antibiotics will applied directly to the skin of the ear canal (topical antibiotics) to fight the infection. These antibiotics are often combined in a preparation that includes a steroid medication that reduces the itching, inflammation and swelling within the ear canal. For full treatment, eardrops are usually applied several times a day for seven to 10 days.

If the opening to the ear is narrowed by swelling, a cotton wick may be inserted into the ear canal to help carry the eardrops into the ear more effectively. The medications are applied directly to the wick, enough times per day to allow the wick to remain continuously saturated. After the wick is removed, usually after about 48 hours, the medications are then put directly into the ear canal three to four times each day.

For severe infection, oral antiobiotics may be prescribed. If the otitis externa infection is caused by the presence of a foreign body in the ear, the infection will not improve until the foreign body is removed.

In malignant otitis externa, antibiotics will almost always need to be given intravenously (IV). If the CT or MRI scan reveals that the infection has spread extensively, these IV antibiotics will need to be continued for six to eight weeks. If the infection is in an earlier stage, two weeks of IV antibiotics can be followed by six weeks of antibiotics by mouth.

Alternative treatment

Mullein (Verbascum thapsus) oil has anti-inflammatory properties and may be apppied to the infected ear canal (one to three drops every three hours) to help soothe and heal the ear. Garlic (Allium sativum) is a natural antibiotic. Garlic juice can be combined with equal parts of glycerin and a carrier oil such as olive or sweet olive and applied (one to three drops) to the infected ear every three hours.

Prognosis

The prognosis is excellent for otitis externa, for it is usually easily treated. Basic treatment measures will cure 90 percent of cases without complication. However, it may recur in certain susceptible individuals. Left untreated, malignant otitis externa may spread sufficiently to cause death.