Introduction
Pain in the auricle occurs particularly in the case of inflammation. There are a variety of inflammations that can cause ear pain. The most important of them will be discussed below:
Outside or inside
Otitis externa is an inflammation of the outer ear, medically known as “Otitis externa”, which causes inflammation of the ear in the outer and sometimes also the inner part of the auricle. Otitis externa diffusa is – as the name suggests – a diffusely distributed inflammation in the area of the entire auricle. It can be caused by bacteria, viruses and also fungi that settle on the skin of the auricle.
But also chronic middle ear inflammations can “migrate outwards”, so to speak, and affect the externally visible area of the ear. However, contaminated swimming pool water is also a major cause of otitis externa. Typical are scaling with simultaneous swelling and a resulting displacement of the eardrum.
However, instead of scaling, weeping may also occur; in any case, hearing performance may be impaired. Therapeutically, antibiotic and cortisone-containing ointments are applied to the outside and inside of the auricle in the case of external otitis. If the auricle and its external environment is reddish and swollen, the diagnosis may be erysipelas.
Erysipelas is by definition an infection of the skin caused by streptococci. Streptococci can penetrate through small skin lesions in the external auditory canal into the tissue and multiply there. After fever and chills, a sharply defined, dark red reddening around the auricle soon appears.
The reddened area is hot, tense, and can extend to the entire auricle including the surrounding area. As with otitis externa, the gold standard of treatment here is antibiotic therapy, although this may also have to be systemic, depending on the severity of the condition. This means that local application of antibiotic ointments to the outer ear may not be sufficient and the antibiotics may have to be administered as tablets or infusions.
A third example, which frequently affects older patients in particular, is the reactivation of a herpes zoster, also known as “zoster oticus” in the ear region. Like normal herpes zoster, oticus zoster casts small bubbles on the outside and inside of the auricle in a strictly limited area, causing painful redness. The pain often occurs even before the blisters are visible.
The zoster settles in the cranial nerves 7 and 8 responsible for the hearing organ, which is why dizziness and hearing loss often accompany it. Since the 7th cranial nerve also carries motor fibers of the facial muscles, this can lead to so-called facial paresis, i.e. paralysis of the facial muscles. Since the zoster oticus is not caused by bacteria but by viruses, antibiotics are not effective in this case.
The therapy is carried out with an antiviral, usually Aciclovir. This prevents the viruses from multiplying, but does not lead to their death. This task must be performed by the body itself. In many cases, the paralysis of the cranial nerves does not regress completely and the loss of function remains. The earlier the zoster is detected and therapy is administered, the better the prognosis.
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