Acute Otitis Externa (Swimmers Ear)

Acute Otitis externa (also called swimmers ear) is an acute condition characterized by diffuse pain in the external ear with infection of the canal skin and underlying dermis of the external ear.

Its much more painful than it seems, so should be treated promptly.

Signs and Symptoms of Acute Otitis Externa (swimmers ear)

Signs and symptoms of AOE (actue otitis externa) include diffuse pain and infection in external ear of acute origin.

There is associated tenderness of tragus and pinna

Sometimes temporomandibular joint (TMJ) is tender too due to acute otitis externa.

Patient has a feeling of fullness in his ear.

Itch is present

Decreased hearing due to canal occlusion occurs secondary to edema.

The external ear canal can be erythematous with purulent (watery) discharge.

Differential Diagnosis of Acute otitis Externa

Differential diagnosis of Acute Otitis Externa include:

  • Acute otitis media with tympanic membrane rupture
  • Acute otitis media with otorrhea secondary to a chronic perforation or tympanostomy tube in place
  • furunculosis
  • herpes zoster / viral otitis externa
  • sequele of foreign body in external ear
  • fungal external otitis
  • contact dermatitis (secondary to contact by offending cosmetics, nickel, drugs, plastic in some hearing aid, etc)

Diagnosis is confirmed on the basis of history and examination by ruling out the possible differentials.

Causes of Acute Otitis Externa

Acute infection in the external ear occurs when the normal epithelial barrier is disrupted.

Infection is 98% bacterial in origin and very uncommonly fungal.

Acute Otitis Externa usually develops secondary to Pseudomonas aeruginosa usually and seldom secondary to Staphylococcus aureus.

Risk factors include trauma from aggressively cleaning ear by the patient, removal of wax, chromic skin conditions like eczema and water exposure (thus named swimmers ear).

When there is enough wax to block the canal, water gets trapped behind it, providing the best medium for bacterial growth in the external ear canal.

Treatment of Acute Otitis Externa

Acute Otitis externa (swimmers ear) requires immediate treatment.

Opiods such as codeine combined with acetaminophen or anti inflammatory drug are given.

Topic therapy via ear drops is the main treatment of choice for acute otits externa.

Bacterial resistance is not a major issue with topic drops.

Culturing the ear is not required prior to treatment.

Irrigation of external ear canal with water and or saline are not recommended in a patient with acute otitis externa. It can even make condition worse.

Oral therapy don’t have any specific use in treatment of acute otitis externa. It’s used usually when the infection has spread to pinna and skin around the ear.

If celulitis has developed as in severe cases, I/V therapy is given.

Treatment is typically effective in first 24-48 hours after which AOE starts to resolve.

If the condition of AOE persists, then referral to a senior or ENT specialist is required, also to rule out carcinoma (squamous cell carcinoma).


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