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Otitis externa

Acid for the ears

Severe earache, redness and swelling can indicate an ear infection. It can be dangerous for diabetics and immune-compromised people.
Marta Campbell
14.03.2022  12:00 Uhr

Otitis externa is extremely painful and one of the most common diseases in ENT practices. It affects the area from the auricle to the eardrum and is usually caused by bacteria. On average, one in ten people will develop it once in their lifetime. The good news is that the inflammation is usually harmless as long as it does not spread to other areas. Otitis externa occurs when the natural environment in the ear canal is disturbed, germs invade and infect the tissue. The earwax (cerumen) normally provides a protective barrier. It absorbs pathogens and dirt particles and transports them away towards the auricle. It also creates a slightly acidic environment, which inhibits the growth of bacteria and fungi.

Frequent contact with water is most detrimental for this natural protective barrier, which is why people who dive a lot or swim in non-chlorinated waters are particularly likely to suffer from the condition also known as swimmer’s otitis, swimmer’s ear or diver’s ear. The water softens the skin in the ear canal and washes away protective earwax.

Excessive cleanliness also disrupts the ear’s natural protection. Soaps or shampoos increase the pH value in the ear canal, so that the protective acidic environment is lost. If you use cotton swabs in your ear, you can cause tiny injuries in the ear canal that increase the risk of infection. In chronic otitis externa, patients usually suffer from underlying dermatological diseases that involve the ear canal, such as atopic dermatitis or psoriasis.

Pain and itching

Patients with signs of otitis externa should consult an ENT specialist. Severe earache is typical of the inflammation, or there is usually also severe itching if fungi are causing the inflammation. Other possible symptoms are otorrhoea, i.e. the discharge of secretion from the external auditory canal, and a reddened and touch-sensitive, sometimes even scaly skin in the auditory canal. If the ear also swells due to the inflammation, patients can no longer hear as good.

The inflammation can affect one ear or extend to both, and the eardrum and auricle can also be affected. Therapy is based on cleaning the ear canal, pain management and the use, if necessary, of antiseptic and antimicrobial substances. The doctor carefully cleans the ear canal. This makes sense because cellular debris and secretions can accumulate in the ear canal due to the inflammation. Only when the deposits have been removed can locally effective medicines also reach their place of application.

Systemic administration of antibiotics is necessary, among other things, when diabetics or people with a weakened immune system are affected. While the inflammation usually heals within one to two weeks without consequences, these two groups have an increased risk of complications. They may develop a special form, a necrotising ear canal inflammation (otitis externa necroticans), in which the inflammation spreads to the skull bone and the cranial nerves. Pseudomonas aeruginosa is often found to be the trigger. Affected persons must be treated in hospital and receive a pathogen-specific parenteral or oral antibiotic therapy according to an antibiogram for at least four to six weeks.


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