II. Definitions
- Otitis Externa
- Diffuse inflammation of the External Ear canal
III. Epidemiology
- Five times more common in swimmers than non-swimmers
- Bilateral involvement in 10% of acute cases
- Age peaks at 7-12 years and decreases after age 50 years
- Lifetime Prevalence: 10%
- Most common in summer
IV. Pathophysiology
V. Causes
- Infectious Causes
- Bacterial Otitis Externa (most common)
- Staphylococcus Aureus
- Pseudomonas Aeruginosa
- Polymicrobial (one third of cases)
- Fungal Otitis Externa (Otomycosis)
- Causes 10% of Acute Otitis Externa cases
- Causes large percentage of Chronic Otitis Externa
- Viral Infection
- Herpes simplex and Herpes Zoster
- Ramsay Hunt Syndrome (herpetic Vesicles in ear canal)
- Herpes simplex and Herpes Zoster
- Bacterial Otitis Externa (most common)
- Noninfectious causes (See Chronic Otitis Externa)
VI. Risk factors
- Moist ear canal
- Swimming
- Sweating
- High humidity in warm environment
-
Generalized skin conditions
- Eczematous Dermatitis
- Seborrhea
- Psoriasis
- Acne Vulgaris
- Contact Dermatitis (e.g. harsh soaps)
- Ear canal obstruction
- Canal stenosis or exostosis
- Cerumen Impaction
- Excessive ear canal hair
- Ear Foreign Body
- Sebaceous Cyst
-
External Ear canal Trauma
- Earphones
- Cotton swabs
- Matchsticks
- Hairpins
- Earplugs
- Hearing Aids
- Finger nails
- Ear plugs
- Prior Radiation Therapy to region (associated with higher compliocation risk)
- Purulent Otorrhea from Otitis Media
VII. Symptoms
- Rapid symptom onset (typically within 48 hours)
- Onset within three weeks of presentation
- Ear Pain or Otalgia (85%)
-
Pruritus (66%)
- Precedes pain in acute inflammation
- Predominant symptom in chronic disease
-
Otorrhea
- Acute Bacterial Otitis Externa
- Scant white mucus (may be thick)
- Chronic Bacterial Otitis Externa
- Bloody discharge with granulation tissue
-
Fungal Otitis Externa (Otomycosis)
- Fluffy discharge
- Color: white, black, gray, blue-green or yellow
- Acute Bacterial Otitis Externa
-
Conductive Hearing Loss
- Associated with swelling and debris in canal
- Systemic symptoms absent
VIII. Signs
- Lymphadenopathy at upper neck or around Ear Auricle
-
Otoscopy
- Ear canal with erythema, edema, and exudate
- Tympanic Membrane mobile
- Visualization often requires removal of Otorrhea
- See Ear Canal Suction
- Cotton-tipped swab (alternative to suction)
- Wisp or fluff cotton out
- Mops up thin watery secretions
- Integral part of ear toilet (see below)
- Pain with movement of the External Ear
- Tragus
- Pinna
IX. Red Flags
- Findings suggestive of infectious spread beyond the ear canal
- Fever over 101
- Severe Otalgia
- Lymphadenopathy
- Trismus
- Cranial Nerve palsy (especially Facial Nerve)
- Patient risk factors associated with Malignant Otitis Externa
- Older patients with Diabetes Mellitus
- Immunocompromised patients
X. Differential Diagnosis
- Infections
- Dermatitis
- Contact Dermatitis (including otic medication sensitization)
- Eczematous Dermatitis
- Seborrhea
XI. Management: General
- Ear toilet
- Ear Canal Suctioning for 2-3 days to remove debris
- Do not put anything in ear including Cotton Swabs
- Oral Analgesics
-
Topical Analgesic
- Precautions
- Avoid if Tympanic Membrane perforated
- May decrease effectiveness of other Topical Medications
- Consider using systemic Analgesics instead (e.g. NSAIDS)
- Agents
- Precautions
- Cotton wick to allow medication penetration
- Cotton
- Gauze
- Compressed hydroxycellulose (Otowick)
-
Tympanic Membrane Perforation or unknown status
- Avoid most topical ear agents (limit to specifically known safe topical agents)
- Avoid Flushing ear
- Return to swimming recommendations
- Consider no immersion for 7 to 10 days
- Competitive swimmers may return in 3 days if no pain
- Consider wearing ear plugs
XII. Management: Cause Specific
- See Ear Canal Instillation for topical otic medication instillation
- Acute Otitis Externa
- See Bacterial Otitis Externa (most acute cases)
- See Malignant Otitis Externa
- See Fungal Otitis Externa (only 10% of acute cases)
- Chronic Otitis Externa
XIII. Prevention
- To avoid getting water in ear while bathing
- Put vaseline coated cotton in ear to cover meatus
- Ear plugs
- Tight fitting bathing cap
- Special care with Shampooing
- After bathing or swimming
- Dry canal with hair dryer on lowest setting
- Avoid ear Trauma
- Avoid cotton-tipped swabs in ear
- Avoid scratching inside ear
- Instill 1-2 drops of one of following qd and prn swim
- White vinegar (or Otic Acetic Acid) 1/3 in Rubbing Alcohol 2/3 OR
- Aluminum acetate (Burow's Solution) in Star-Otic
XIV. Complications
XV. Resources
XVI. References
- Beers (2004) Pediatr Emerg Care 20:250-6 [PubMed]
- Bojrab (1996) Otolaryngol Clin North Am 29:761-82 [PubMed]
- Dohar (2003) Pediatr Infect Dis J 22:299-305 [PubMed]
- Halpern (1999) J Am Board Fam Pract 12(1):1-7 [PubMed]
- Jackson (2023) Am Fam Physician 107(2): 145-51 [PubMed]
- Mirza (1996) Postgrad Med 99:153-8 [PubMed]
- Osguthorpe (2006) Am Fam Physician 74:1510-6 [PubMed]
- Rosenfeld (2006) Otolaryngol Head Neck Surg 134 (4 suppl): S4-23 [PubMed]
- Sander (2001) Am Fam Physician 63:927-42 [PubMed]
- Schaefer (2012) Am Fam Physician 86(11): 1055-61 [PubMed]
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Definition (NCI_CTCAE) | A disorder characterized by inflammation, swelling and redness to the outer ear and ear canal. |
Definition (NCI) | An acute or chronic inflammatory process involving the skin of the outer ear and the ear canal. |
Definition (MSH) | Inflammation of the OUTER EAR including the external EAR CANAL, cartilages of the auricle (EAR CARTILAGE), and the TYMPANIC MEMBRANE. |
Concepts | Disease or Syndrome (T047) |
MSH | D010032 |
ICD10 | H60 , H60.9, H60.90 |
SnomedCT | 155215003, 194224008, 155209003, 267667005, 267751009, 3135009 |
English | Externa, Otitis, OTITIS EXTERNA, Otitis externa NOS, Otitis externa, unspecified, External Otitis, Otitides, External, Otitis, External, External Otitides, otitis externa (diagnosis), otitis externa, External Ear Inflammation, Inflammation of External Auditory Canal, Inflammation of the External Auditory Canal, Otitis Externa, Unspecified otitis externa, Unspecified otitis externa, unspecified ear, Otitis Externa [Disease/Finding], externa otitis, external otitis, otitis external, Otitis externa NOS (disorder), Inflammation external ear &/or otitis externa NOS (disorder), Inflammation ear external, Inflammation external ear &/or otitis externa NOS, Otitis externa, OE - Otitis externa, Otitis externa (disorder), ear; inflammation, external, externa; otitis, external auditory canal; inflammation, inflammation; ear, external, inflammation; external auditory canal, otitis; externa, Otitis externa, NOS, External ear inflammation |
French | OTITE EXTERNE, Inflammation de l'oreille externe, Otite externe SAI, Otite externe |
Portuguese | OTITE EXTERNA, Inflamação do ouvido externo, Otite externa NE, Otite do Canal Auditivo Externo, Otite externa, Otite Externa |
Spanish | OTITIS EXTERNA, Inflamación del oído externo, Otitis externa NEOM, Otitis del Conducto Auditivo Externo, Otitis externa NOS, otitis externa, SAI (trastorno), otitis externa, SAI, otitis externa (trastorno), otitis externa, Otitis externa, Otitis Externa |
German | OTITIS EXTERNA, Entzuendung des aeusseren Ohres, Otitis externa NNB, Otitis externa, nicht naeher bezeichnet, Otitis externa, Entzündung des äußeren Gehörgangs, Gehörgangsentzündung |
Dutch | uitwendig oor ontsteking, otitis externa NAO, externa; otitis, ontsteking; oor, uitwendig, ontsteking; uitwendige gehoorgang, oor; ontsteking, uitwendig, otitis; externa, uitwendige gehoorgang; ontsteking, Otitis externa, niet gespecificeerd, otitis externa, Otitis externa |
Italian | Infiammazione dell'orecchio esterno, Otite esterna NAS, Otite esterna |
Japanese | 外耳の炎症, 外耳炎NOS, ガイジノエンショウ, ガイジエンNOS, ガイジエン, 外耳炎 |
Swedish | Öroninflammation, yttre |
Czech | zevní ucho - zánět, zánět zevního ucha, otitis externa, Otitis externa NOS, Otitis externa, Zánět vnějšího ucha |
Finnish | Ulkokorvatulehdus |
Russian | OTIT NARUZHNYI, ОТИТ НАРУЖНЫЙ |
Korean | 상세불명의 바깥귀길염, 바깥귀길염 |
Croatian | OTITIS EKSTERNA |
Polish | Zapalenie ucha zewnętrznego |
Hungarian | külsőfül gyulladás, otitis externa k.m.n., Otitis externa |
Norwegian | Betennelse i øregangen, Betennelse i det ytre øret, Otitis externa |
Ontology: Acute infective otitis externa (C0339759)
Concepts | Disease or Syndrome (T047) |
ICD10 | H60.33 , H60.339 |
SnomedCT | 194200000, 267665002 |
English | swimmer's ear, acute infective otitis externa, acute infection of external ear (diagnosis), acute infective otitis externa (diagnosis), acute infection of external ear, Acute infective otitis externa, acute swimmer's ear, Swimmer's ear, Swimmer's ear, unspecified ear, Acute infective otitis externa (disorder), Acute infective otitis externa NOS |
Spanish | otitis externa infecciosa aguda (trastorno), otitis externa infecciosa aguda |