Symptoms
Acute otitis externa is an inflammation of the external auditory canal. The pinna and eardrum may also be involved. Possible symptoms include itching, ear pain, skin redness, swelling, a feeling of fullness and pressure, impaired hearing, and a discharge. Fever and swelling of the lymph nodes may also occur. Pain worsens with chewing. Complications: The disease may interfere with normal daily activities and in some cases may even require bed rest. If inadequately treated, the infection may spread to surrounding tissues. Chronic otitis externa caused by fungi may occur after treatment with topical antibiotics.
Causes
In most cases, acute otitis externa is caused by bacteria. The most common pathogens are and . Less commonly, the infections are caused by fungi or herpes viruses. Risk factors:
- Humidity, swimming, sweating, possibly also poor water quality.
- Warm temperatures, warm climate
- Insertion of foreign objects such as hearing aids, hearing protection.
- Mechanical removal of earwax, insufficient earwax formation.
- Local injuries and skin diseases
- Impurities
- Anatomical anomalies
Diagnosis
Other diseases such as malignant otitis externa, otitis media, ear plug, abscesses, eczema, fungal infections, viral infections, allergic contact dermatitis or sore throat can cause similar symptoms. Skin diseases such as atopic dermatitis or psoriasis can also occur in the ear canal.
Prevention
- The ear canal should be protected from water and moisture and dried well after swimming. The use of ear protection is not without controversy, because it can promote the emergence by local irritation.
- Earwax should not be removed regularly with cotton swabs, because it has an important protective function against infections and cares for the skin. It is slightly acidic, antimicrobial, protects against softening and thus inhibits bacterial growth.
- Diver drops are antiseptic, nourishing and acidic ear drops, which are designed to reduce the colonization of bacteria in the ear canal. They are used before and/or after swimming or even before going to bed. See under diving drops.
Non-drug treatment
Patients should not touch the ear canal, for example, do not scratch when itching. Also, water should not enter the ear canal during treatment. The use of special hearing protection or a shower cap before showering or bathing is therefore recommended. Hearing aids should not be used during treatment. An ear rinse with lukewarm water or saline solution removes dirt and may relieve discomfort. It is usually performed under medical treatment.
Drug treatment
The prerequisite for the success of the therapy is the correct application of the ear drops by the patient. see under Ear drops. In addition, it is important to note that many ear drops should not be used in cases of eardrum perforation because they are ototoxic and can lead to hearing loss! Ear drops:
- First-line agents for acute otitis externa caused by bacteria are antibiotic ear drops. Approved agents in many countries include quinolones (ciprofloxacin), aminoglycosides (neomycin), and polymyxins (polymyxin B). Topical administration achieves a high local concentration and largely avoids adverse effects of systemic treatment. Alternatively, local antiseptics such as acetic acid are also used.
- Glucocorticoids such as hydrocortisone, dexamethasone, or fludrocortisone are anti-inflammatory, decongestant, antiallergic, and antipruritic. They are usually included in combination preparations together with antibiotics.
Oral antibiotics:
- The use of oral antibiotics is controversial because the pathogens are not sensitive in some cases, topical treatment is also effective, and internal administration can cause adverse effects. In severe cases or contraindications, they may be indicated.
Analgesics:
- Such as ibuprofen, paracetamol or the opioids are effective when used internally against pain and partly against the inflammation.Due to the adverse effects, the use should be limited to a few days. Local pain treatment with local anesthetics or local NSAIDs such as phenazone is controversial.
