Otitis externa

Otitis externa is a condition where there is infection or inflammation of the skin of the outer ear canal. This often occurs secondary to excessive exposure to water, such as during a swimming holiday or in people who frequently shower or bathe. In addition it can be brought on by damaging the ear canal skin through using cotton buds or sometimes following ear syringing. Occasionally it occurs as a true eczema when there is a sensitivity to some substance used locally, such as shampoo, hairspray, facial creams or suntan lotion.

Symptoms:
The most common symptom of mild otitis externa is itching. This is usually a sign that the skin of the ear canal is becoming unstable and precautions should be taken at this stage. If the condition progresses, then the ear canal will begin to swell up, the hearing will become muffled, and pain and discharge may occur.

Treatment:
The condition is generally managed by local treatment, usually with drops, and making change to some lifestyle habits.

  1. Medical treatment may be given. Steroid drops are useful for treating any underlying eczema. Antibiotic ear drops with steroids are often used for infection in the ear canal. Anti-fungal drops may be given in cases of fungal otitis externa.
  2. Avoid rubbing ears. it is most important to avoid using cotton buds as this can traumatise the ear canal where it can cause the skin to become inflamed. The ear canals do not need cleaning and wax has actually got anti-infective properties, and so a reasonable amount of wax is good for the ear canals.
  3. Keep the ears dry. Water exposure can cause the problem, and therefore, it is important to keep the ears meticulously dry for at least 2 weeks after the ear symptoms have settled. This can be done, either by swim plugs from a chemist or making waterproof plugs using cotton wool coated in Vaseline. These plugs should be inserted into the ear canal before any water exposure, such as showering. Sometimes it may be necessary to keep the ear dry long term if one has a particular susceptibility to recurrence of otitis externa.
  4. Earcalm spray (2% acetic acid) ear drops can sometimes be useful in reducing the risk of inflammation or infection after water exposure. These can be bought over the counter at most chemists and can be applied as 2 drops to each ear, twice daily, for up to a couple of weeks. These can be very useful during swimming holidays to try to prevent recurrence of otitis externa.
  5. Stop smoking. The condition is often more troublesome and recurs more frequently in smokers. Cigarette smoke is known to damage the skin.
  6. Consider changing any shampoos, creams or sprays that may be used locally just in case there is a generalised sensitivity to them.
  7.  If you normally wear a hearing aid in an ear that is inflamed, it is worth trying to leave the aid out as much as possible to allow the condition to get better. The condition often persists if the ear canal is hot and humid. If this becomes a recurrent problem, then it may be worth considering asking for a hypoallergenic or ventilated mould from the Audiology Department.
  8. Ear canal cleaning is sometimes required, and this is best done in the Hospital by a Doctor or Nurse using a microscope with a suction device or sometimes using a very bright headlight and cotton wool to mop the ear canal. Do not attempt to clean the ear yourself as this is likely to make it worse.
  9. Rarely sensitivities occur to the antibiotic ear drops, and if you experience worsening of pain or symptoms after starting the ear drops, please consult me.

If you would like any further information, please do not hesitate to contact me.

Mr Philip J Robinson MB FRCS FRCS (Otol)
PA: Mrs Beverley Bloor 
Tel: 0117 9804050 
Beverley.bloor@spirehealthcare.com 

Spire Bristol Hospital
The Glen
Redland Hill
Bristol
BS6 6UT

Appointments: Tel: 0117 9804070