“Infection of the external auditory meatus (a.k.a. swimmer’s ear)”

Risk Factors
  • Frequent water contact (e.g. swimming)
  • Immunocompromised / diabetes (also increased risk of complications)
  • Humid environment
  • Local trauma (e.g. cotton bud use, hearing aids)
  • Presence of ear polyps, psoriasis or eczema
Aetiology
  • Most commonly bacteria (pseudomonas, s. aureus)
  • Rarely fungi (aspergillus, candida)
Pathophysiology
  • Disruption of the protective mechanisms of the external auditory canal (EAC) may lead to pathogen overgrowth and subsequent inflammation.
  • Disruption may be caused by:
    • Interruption in wax formation (e.g. repeated water exposure)
    • Trauma to the EAC (e.g. cotton bud use)
    • Blockage of the EAC (e.g. debris)
  • This causes swelling, otorrhoea and debris accumulation, which contribute to further entrapment of pathogens and propagation of the inflammatory response.
Clinical Presentation
  • Typically presents as progressive unilateral otalgia with purulent otorrhoea
  • Patients commonly experience itchiness or a sensation of ear fullness
  • Less common symptoms include tinnitus, hearing loss and swelling
  • Exam may show swelling and erythema of the EAC, tragal tenderness, otorrhoea
Investigations
  • Diagnosis is based on clinical presentation, however, ear swabs should be considered in recurrent, chronic or non-resolving cases to identify the causative organism
Management
  • OTC analgesia (paracetamol, ibuprofen)
  • Removal of debris from the external auditory canal
  • Topical ear drops (e.g. Otomize: neomycin + dexamethasone + acetic acid)
  • Avoidance of contributing factors (e.g. swimming
Complications
  • Malignant otitis externa: (infection invades bone at the skull base, causing osteomyelitis)

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