Otitis externa or swimmer’s ear is a medical condition characterized by infection of the external ear canal. Otitis externa and otitis media are the two most common causes of ear pain. Other than humans otitis externa may also occur in animals of other species. The overlying skin in the external canal becomes inflamed in otitis externa.
This inflammation may occur either due to bacterial or fungal infections or secondarily following eczema like skin infections. Usually persistent presence of water in the ear canal especially after swimming is the main contributory factor as the moist environment facilitates bacterial and fungal growth in the ear canal. Sometimes ear picking by putting fingers, sharp objects in the eat canal may lead to injury to the skin overlying the external ear canal and may induce bacterial infection.
The presenting symptoms usually vary in severity depending upon the extent of the disease. Serious complications like temporary loss of hearing, spread of infection to the deeper tissue (cellulitis) etc may arise in severe cases if treatment is delayed.
Treatment options include cleaning of the ear canal, application of antibiotic and or antifungal ear drop as per the underlying cause; steroid ear drops etc are administered. Certain precautions are to be taken to stop further entry of water in the ear canal like avoiding swimming, flying, scuba diving etc.
Common presenting symptoms
In most of the cases initial symptoms are mild which can become severe without adequate treatment on time. The symptoms are usually classified as per severity as mild, moderate and severe.
Mild symptoms include
1. Itching sensation with minimal pain inside the ear along with slight reddening of the ear canal,
2. sometimes little amount of colorless and odorless ear discharge may occur
3. the pain may worsen upon pulling the external ear or the pinna or pressing on the tragus (the slight swelling in front of the ear)
Moderate symptoms include
1. Increased itching, pain and redness in the outer canal of the ear,
2. Increased amount of ear discharge; sometimes pus may also come out
3. Continuous feeling of heaviness or fullness in the ear due to obstruction of the ear canal by different cellular debris, fluid and swelling of the skin of the external ear canal
4. Muffling of sound, inability to hear sound clearly may also occur due to obstruction of the ear canal.
Severe symptoms include
1. Increase in pain, discomfort in the ear occurs to such an extent that normal day to day activity, night time sleep is hampered
2. The lymph nodes (glands) in the neck may become swollen
3. High degree of fever may also occur
Without prompt and adequate treatment otitis externa may lead to number of complications namely
1. Temporary loss of hearing: muffling of sound may occur due to obstruction if the ear canal leading to poor transmission of sound
2. Chronic otitis externa: sometimes the symptoms of acute otitis externa may persist for long period; usually if the symptoms persist for more than 3 weeks it is called as chronic otitis externa. This condition usually arises due to infection by a resistant strain of bacteria, allergy to administered antibiotic drop , allergic skin condition, infection by both bacteria and infection
3. Cellulitis: under rare circumstances the infection of otitis externa may spread to deeper layers of the tissue resulting into cellulitis
4. Necrotizing otitis externa: it is a very serious complication of otitis externa where the infection spreads to the skin and cartilage to the outer ear (pinna) even bones of the skull in this area may also be affected. This condition is more common in people suffering from diabetes, poor immune status etc. Although known as malignant otitis externa it is not a type of cancer.
5. Sometimes the infection may spread to other adjacent structures like the brain, nerves etc jeopardizing the life of the affected patient.