A persistent or recurrent inflammation or infection of the external ear and ear canal.

Alternative Names

External ear infection - chronic; Swimmer's ear - chronic; Chronic otitis externa

Causes, incidence, and risk factors

Swimmer's ear ( otitis externa ) is fairly common. It usually responds to treatment, but about 1% of cases may become chronic . It consists of inflammation, irritation, or infection of the outer ear and ear canal. There may be a history of exposure to water or of mechanical trauma to the ear from scratching or foreign objects in the ear. Swimming in polluted water is one way to contract swimmer's ear. The presence of moisture predisposes the ear to infection from fungus or water-loving bacteria such as pseudomonas. Chronic otitis externa may occur as a result of inadequate treatment, or may suggest the presence of disease in underlying bone, a complication described as malignant otitis externa .

Signs and tests

Inspection

shows the ear to be red and swollen, including the ear canal. The eardrum may be difficult to see with the

otoscope , or the eardrum may appear red. However, the eardrum is more mobile than is seen with otitis media. The ear canal may appear eczema-like, with scaly shedding of skin in the canal. Touching or manipulating the outer ear increases pain; the outermost part of the ear, the tragus, may ultimately become infected, and appear red and swollen.

Treatment

The goal of treatment is cure of the infection, and consists of topical application of ear drops containing antibiotics to fight infection and corticosteroids to reduce itching and inflammation. Sometimes other remedies such as acetic acid (vinegar) drops may be used. If the ear canal is very swollen, a wick may be placed in the ear to allow the drops to travel to the end of the canal. Analgesics may be used if pain is severe. In elderly individuals or diabetics with persistent ear pain and/or persistent drainage, malignant otitis externa is a possibility. The ears should be evaluated with CT scanning to look for erosion of bone. Treatment of malignant otitis externa is with high-dose intravenous antibiotics effective against Pseudomonas aeruginosa .

Expectations (prognosis)

Chronic otitis externa usually responds to treatment. Treatment may be prolonged or repeated. If untreated, complications may develop.

Complications

cellulitis (infection of the surrounding skin)

malignant otitis externa

, which can cause bone infection, hoarseness, and difficulty swallowing

Calling your health care provider

Call for an appointment with your health care provider if symptoms of chronic otitis externa develop; or if acute otitis externa does not respond to treatment.

Prevention

Dry the ear thoroughly after exposure to moisture. Individuals who swim frequently should use earplugs. Otitis externa should be treated completely, and treatment should not be discontinued sooner than recommended by the health care provider.