Otitis externa - causes, symptoms, treatment

Treatment of external otitis in ENT clinic No. 1

Author:

Chernova Olga Valerievna
otorhinolaryngologist

5.00 (Votes: 1)

Otitis externa is an inflammation of the skin of the external auditory canal or pinna. Most often caused by a bacterial pathogen (Pseudomonas aeruginosa, St. epidermitis, Staphylococcus aureus, etc.) or fungal flora (Candida, Aspirgella).

The classification distinguishes between acute external otitis and chronic (duration more than 4 weeks or exacerbations more than 4 times per year).

Inflammation of the skin of the ear canal can be local (limited) in the form of boils and carbuncles in the cartilaginous part of the ear canal or diffuse (along the entire length of the cartilaginous part of the ear canal).

Non-infectious external otitis is also distinguished - eczema, seborrhea, neurodermatitis, contact dermatitis.

What is otitis externa?

This is an inflammation of the tissues of the external auditory canal, eardrum and auricle. Otitis externa is widespread. It is considered acute if it lasts less than 4 weeks, chronic if it lasts longer and/or occurs more than 4 times a year.

IMPORTANT! Information from the article cannot be used for self-diagnosis and self-medication! Only a doctor can prescribe the necessary examinations, establish a diagnosis and draw up a treatment plan during a consultation!

GBOU "NIKIO im. L.I. Sverzhevsky" of the Moscow Department of Health

Treatment of external otitis

Otitis externa is an inflammatory process that develops in the external auditory canal (the area that leads outward from the eardrum). Almost everyone is susceptible to this disease, but most often it occurs in preschool children. Regardless of the causes of inflammation, treatment of external otitis should be carried out in a timely manner and taking into account all the features of the clinical picture, since if left unattended, this disease can lead to serious complications.

Symptoms of external otitis

The symptoms of otitis externa are quite characteristic and “recognizable” - to identify inflammation of the ear canal, it is enough to know its key signs:

Earache. In most cases, otitis externa develops on one side, and constant pain is felt in the inflamed ear canal, which patients describe as “pressing”, “bursting”.
Pain in the ear. When you touch the concha and, especially, the tragus (a small protrusion in front of the auditory opening, directed towards the cheekbone), the pain intensifies greatly and can take on a “shooting” character.
Feeling hot. The auricle and surrounding tissues feel hotter than on the healthy side, and the feeling of heat persists regardless of the general body temperature.
Discharge from the ear. Depending on the type of pathogen that caused the inflammation, discharge from the external auditory canal may be clear and watery, have a yellow tint, or be purulent.
Decreased hearing acuity. On the inflamed side, there is a feeling of congestion, and sounds are heard muffled, as if through cotton wool. In severe cases of the disease, a “transfusion” of fluid may be felt in the ear, which causes serious discomfort.
Increased body temperature. Depending on the severity of the disease, the pathogen that caused the inflammation and the age of the patient, the temperature can rise to 38-40°C. At the same time, lower values are more often observed in adults, and upper values in children, which is due to the immaturity of the child’s immune system, which reacts violently to the presence of infection.

In addition to the listed symptoms, which are directly related to otitis media, other signs are observed that indicate the negative impact of the inflammatory process on the entire body. Among them are increased fatigue, headache, irritability, sleep and appetite disturbances.

It should also be remembered that depending on the type of otitis externa, symptoms can be combined in various combinations, and also be supplemented by others (for example, the formation of an abscess in the external auditory canal).

Causes of otitis externa

In all cases of otitis, the disease is caused by pathogenic microorganisms that are literally present everywhere - in water, air, soil, food, etc.

But they cause inflammation in the external auditory canal only in the presence of predisposing factors - circumstances that facilitate the penetration of pathogens and create favorable conditions for their growth and reproduction.

These include:

injuries to the external auditory canal, in which the integrity of the skin is compromised - most often this is caused by the use of unsuitable items for hygiene (matches, hair clips, etc.);
insufficient hygiene of the external auditory canal, in which accumulations of sulfur and sebaceous gland secretions create a breeding ground for pathogens;
recently suffered from acute respiratory viral infections, influenza, etc. - while the general state of the immune system worsens, which reduces the body’s resistance to infections;
diseases of the ENT organs - rhinitis, tonsillitis, sinusitis, etc., left without treatment, can cause infection to spread to the middle ear cavity, from where pathogens move into the external auditory canal;
hypothermia, temperature changes (for example, moving from a warm room to a cold one), which are also factors that reduce the body's defenses.

Treatment of external otitis necessarily involves identifying the reasons why the disease developed and eliminating them - otherwise, therapy may be ineffective.

Types of external otitis

Treatment of otitis media largely depends on the type of disease, which is classified according to the characteristics of the course and the extent of inflammation.

Thus, it is customary to distinguish between acute and chronic otitis media. In the first case, the disease manifests itself acutely, and the symptoms are pronounced. With chronic otitis media, the main symptoms (pain, fever, etc.) may be completely absent or appear very slightly. But with hypothermia, a cold and in the presence of other predisposing factors, the disease worsens, “activating” all the symptoms characteristic of otitis media.

According to the prevalence of the disease, limited and diffuse otitis media are distinguished.

Limited otitis is the introduction of infection into the lumen of the sebaceous ducts or hair follicle, after which a furuncle (painful swelling, which, as it matures, is filled with purulent contents) forms in the lesion.

With diffuse otitis, inflammation of the entire surface of the external auditory canal is observed, without clearly defined individual foci.

Diagnostics

When a patient consults a doctor with complaints of ear pain, decreased hearing acuity and other symptoms characteristic of otitis externa, a comprehensive examination is carried out.

Among the routine methods (mandatory in all cases) is otoscopy, examination of the external auditory canal using a special device. This procedure is painless and does not require anesthesia, but it provides the doctor with enough information to confirm the diagnosis of otitis externa, determine the type of disease, identify complications if they have already developed and help set the direction for further diagnosis.

In addition to otoscopy, the following diagnostic methods may be recommended:

laboratory tests of a sample of secretions taken from the ear canal, which make it possible to identify the causative agent of the disease and determine the group of drugs necessary for treatment;
assessment of hearing acuity is necessary in cases where the inflammation is chronic and the doctor has reason to suspect hearing impairment as one of the complications of otitis media;
Consultation with other specialists (infectious disease specialist, allergist-immunologist, etc.) may be recommended if the ENT sees this as necessary.

Comprehensive diagnostics is a necessary measure that allows you to accurately determine the cause of the disease, identify all possible complications or concomitant ailments, and prescribe treatment that best suits the given clinical situation.

Complications of otitis externa

Treatment of external otitis can rightfully be called not only a measure to eliminate the disease itself and its symptoms, but also the prevention of a number of complications.

The consequences of inflammation of the external auditory canal are so varied and severe that without adequate therapy, the development of complications is almost impossible to avoid. The most common of them are the following:

Transformation of otitis media into a chronic form. The infectious and inflammatory process goes into a “dormant” state, only to be activated each time in the presence of unfavorable factors.
Destruction of hard tissues of the external auditory canal. The bones and cartilage that form the ear canal can begin to break down and die when exposed to pathogens and the toxins they produce.
Spread of infection to other tissues and organs. Treatment of external otitis can prevent infection of the eardrum and its perforation, inflammation of the middle and inner ear, orbital complications (developing in the soft and bone tissues of the orbit) and even brain damage. The most dangerous complication can be considered sepsis - the penetration of pathogens into the bloodstream and their spread throughout the body. Although such cases are rare, this does not diminish their severity - without providing the patient with emergency medical care, the prognosis is extremely unfavorable.

Drug treatment

Treatment of external otitis is carried out taking into account the results of the examination. So, when bacteria responsible for inflammation are identified, antibacterial drugs of the appropriate group are prescribed. For fungal infections of the external auditory canal, antimycotic agents are used.

In addition, the causes of the disease and the severity of the lesions determine the prescription of drugs with local or systemic action, or a combination thereof.

Physiotherapeutic treatment (UV therapy, electrophoresis, magnetic therapy and other methods) is also used.

The choice of drugs, the duration of the course of therapy and the combination of certain methods and means remains with the attending physician.

Treatment at the NIKIO clinic

At the Research Clinical Institute of Otorhinolaryngology named after. L.I. Sverzhevsky (NIKIO) treats external otitis using both classical regimens, which have proven to be highly effective, and with the help of the latest developments in the field of otolaryngology.

The diagnostic and treatment facilities of NIKIO are represented by the latest generation equipment, which allows one to quickly identify the causes and complications of the disease, as well as carry out therapy taking into account all aspects of the disease.

Outpatient and inpatient departments are presented to the attention of patients, as well as all currently existing treatment methods, as well as rehabilitation programs for people with hearing impairment and other pathologies.

To make an appointment, call 633-97-61 and remember: timely consultation with a doctor is the best guarantee of health and longevity.

Symptoms of external otitis

There are three degrees of severity of otitis externa.

Mild external otitis: itching in the ear canal, redness inside the ear, discomfort in the ear, which intensifies when pressing on the auricle or tragus (small protrusion in the center of the auricle). A small amount of clear, odorless fluid may come out of the ear.
Moderate external otitis: the itching becomes stronger, the ear hurts, there is obvious redness inside, the discharge intensifies, and pus may appear. The auditory canal feels full as a result of swelling and retention of discharge.
Diffuse external otitis: severe pain in the ear, radiating to the neck, temple, cheek; the ear canal is completely blocked; the auricle becomes red and swollen, as do the lymph nodes in the neck. The temperature is elevated, sometimes significantly.

Possible complications of otitis externa

As a rule, otitis externa does not cause complications and is easily treated. However, if complications do occur, they may include the following:

temporary hearing loss in the affected ear. Goes away after recovery from otitis media;
chronic external otitis. It usually occurs when there are difficulties in treating external otitis, for example, in fungal and mixed bacterial-fungal forms;
spread of infection to deep tissues - cellulitis of the neck, lymphadenitis, osteomyelitis. Similar complications (malignant otitis media) can occur in patients with immunodeficiency conditions, diabetes, and those receiving chemotherapy. Such complications can be life-threatening.

How to prevent otitis externa?

Gently blot the ear canal after bathing, but do not wipe the ear canal itself with anything.
If water gets into your ear, you can shake it out by jumping on one leg and tilting your head to the same side. You can also dry the water in your ear with a hairdryer, setting it to the lowest setting and holding it about 30-40 cm from the ear.
If you know your eardrum has been damaged or punctured, you can use ear drops that will prevent bacteria from growing in your ear once water enters the eardrum.
Don't swim in dirty waters.
Do not reach into the ear canal with a finger, a stick, a cotton swab or a swab - in a word, nothing.
Protect your ears when using hairspray if you know it may irritate the skin inside your ear canal;
If you have had ear surgery or ear infections, see an ENT before swimming.

Causes of the disease

If the cause of the disease in adults is bacteria and viruses, we are talking about the infectious nature of the inflammation. The causative agents of otitis media can be Pseudomonas aeruginosa, staphylococcus, fungi, etc. External factors can also cause inflammation. What provokes the development of the disease?

failure to comply with basic hygiene rules, when ears are washed rarely and poorly;
in contrast to the first point - excessive hygiene, when an adult cleans wax from the ear canal almost every day and with great diligence. This is a big mistake - the sulfur released has an antibacterial effect and is a natural defense against infection. It is enough to clean your ears twice a week;
damage to the tissues of the ear canal in the process of improper cleaning of the ears - many adult patients go to the doctor because they choose objects not intended for ear hygiene: knitting needles, toothpicks, matches. The skin of the ear canal is very delicate, and picking at it with sharp objects can easily injure it. Pathogenic microflora penetrates through these microtraumas;
very deep cleaning of the ear is also fraught with damage to it - do not insert the cotton swab deep into the cleaning process; for children's hygiene, use special cotton swabs with limiters;

insufficient sulfur production;
excessive sulfur production, leading to sulfur plugs;
foreign objects getting into the ear - this problem is especially relevant for children. While playing, children put everything into their ears out of curiosity: beads, buttons, small parts from toys, which damage the delicate tissues of the ear canal;
water often getting into the ear - the water washes away the natural defense - wax, and accordingly, the infection easily settles on the skin; and if swimming takes place in dirty stagnant water, for example, in a polluted pond, this is an additional chance of getting sick;
reduced immunity especially in adult patients at risk (HIV infection, tuberculosis, oncology, diabetes, etc.);
infectious diseases currently occurring in the body (tonsillitis, sinusitis, otitis media, etc.);
improper use of medications;
allergic reactions;
skin diseases.

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As we can see, the list is extensive. In order to start treatment on time, you must be able to recognize the symptoms of acute inflammation.

Diagnosis of external otitis

Usually it is not difficult. Otitis externa is easily identified by its symptoms and the appearance of the ear and ear canal. The doctor may examine your ear with an otoscope. If he wants to make sure that the eardrum is intact, he can use a curette to clean the ear and take a deeper look.

If the otitis is diffuse, the doctor may need additional diagnostics of the condition of the middle ear, determining the nature of the otitis (bacterial or other), etc.

Sources

Kesser BW Assessment and management of chronic otitis externa. Current Opinion in Otolaryngology & Head and Neck Surgery. 2011, 19: 341–347.
Roland PS, Stroman DW Microbiology of acute otitis externa // Laryngoscope. - 2002. - Vol. 112, No. 7, Pt. 1. - P. 1166-1177.
Rosenfeld RM, Brown L, Cannon CR et al. Clinical practice guideline: acute otitis externa // Otolaryngology. Journal of Otolaryngology - Head & Neck Surgery. - 2006. - Vol. 134 (4 Suppl). - P. 4-23.
Schaefer P., Baugh RF Acute otitis externa: an update. American Family Physician. 2012, Dec; 1-86 (11): 1055-61.
Wiegand S., Berner R., Schneider A., Lundershausen E., Dietz A., Otitis Externa: Investigation and Evidence-Based Treatment. Archive of "Deutsches Ärzteblatt International". 2022, Mar; 116 (13): 224–234.

Gurov A.V., Yushkina M.A. Features of the clinical course and etiotropic therapy of external otitis. Russian medical journal. 2016. – T. 24. – No. 21. – P. 1426-1431.

Treatment of external otitis

The goal of treatment is to stop the spread of infection and allow the ear canal to clean itself as it normally does.

Cleaning and rinsing the ear canal. As a rule, the doctor cleans it with a curette to free it from skin particles, stuck earwax and dried discharge (serous or purulent). This is necessary so that the ear drops can spill to the entire depth of the ear canal.
Ear drops prescribed by an ENT or general practitioner (GP). Usually these are drops with antibiotics and/or corticosteroids. For severe pain, analgesics can be used.
If there is severe swelling of the external auditory canal, the doctor may first replace the drops with turunda soaked in medicine. When the swelling subsides, the turunda can be easily removed from the ear, and you can continue to be treated with drops.
When instilling cold drops, hold them in your palm for a while to reduce discomfort. After the drops are in your ear, lie down on your healthy side for a few minutes so that the drops are better absorbed. You can ask someone to instill drops for you - this is more convenient.
If the infection is widespread, the doctor may prescribe oral antibiotics in addition to drops.

Diagnosis and treatment.

Symptoms of otitis externa are usually intense and very disturbing.
Lack of proper treatment can lead to dangerous complications, so it is better not to delay visiting a doctor. It is necessary to conduct an ENT examination and determine the causative agent in order to begin appropriate treatment. For bacterial infections, topical antibiotics (eg in the form of ear drops) are used, and systemic antibiotics may be required for general symptoms. Fungal infections require the administration of antifungal agents, usually in the form of an ointment or suspension. Antiviral drugs are used to treat ear herpes. The goal of therapy is not only to eliminate the pathogen, but also to reduce unpleasant pain. As a rule, drugs based on paracetamol or ibuprofen are used, which can be purchased at the pharmacy without a prescription.

For otitis media, it is better to use a drug from the group of non-steroidal anti-inflammatory drugs based on ibuprofen or, in case of severe pain, metamizole sodium or ketoprofen. However, it is important to always follow the recommended dosage.

For topical use, you can use drops containing a local anesthetic - lidocaine) or an anti-inflammatory substance - choline salicylate.