Otitis externa is an infection of the outer ear canal, often called swimmer's ear because moisture and small injuries to the canal let bacteria grow. Pseudomonas and Staphylococcus aureus are the usual causes.
Key symptoms
- Ear pain, worse when the ear is pulled
- Itching and a feeling of fullness
- Discharge from the ear
- Muffled hearing
What you find on exam
- Pain when moving the tragus or pinna
- Red, swollen ear canal with debris
- Eardrum may be hard to see
- Check for spreading redness of the outer ear or face
Tests
- Diagnosis is clinical
- Culture of the discharge if severe or not improving
- Glucose and CT if necrotizing otitis externa is suspected
Treatment basics
- Antibiotic ear drops such as ofloxacin, or ciprofloxacin with dexamethasone
- Gentle cleaning of the canal and a wick if very swollen
- Pain relief with ibuprofen or acetaminophen
- Keep the ear dry for 7 to 10 days
- Oral antibiotics only if the infection spreads beyond the canal
Red flags
- Severe, lasting pain in an older patient with diabetes (necrotizing otitis externa)
- Facial weakness or another cranial nerve palsy
- Fever with spreading redness
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.