Management of Otitis Externa by Organism - Specific Therapy

What Is Otitis Externa?

Otitis externa is also known as the swimmers’ ear. This is the infection or the inflammation of the external ear canal. Since the external ear canal is dark, warm, and can contain, it forms a suitable environment for the bacteria and fungus to grow, resulting in infection. It is called the swimmer's ear, as it affects the people who spend most of their time in the water.

What Causes Otitis Externa?

Otitis externa can be caused due to water getting into the external ear canal. So getting involved in water activities for a long duration can make people prone to getting this infection. The other possible causes of this condition are:

• Being in a warm and humid place.

• Removal of ear wax which is a natural protectant of the ear against infections.

• Injury to the ear is caused by introducing foreign objects into the ear, such as nails, pencils, fingers, paper clips, or hair clips.

• Swimming in polluted water.

• Skin conditions such as eczema or psoriasis can also affect this.

The otitis externa is mostly caused by bacteria; also, there are some fungi that can cause this infection. The most commonly seen bacteria involved in this are belonging to the Pseudomonas species, Staphylococcus species, and anaerobes and gram-negative bacteria. The fungal otitis externa may be caused as a result of overtreatment with topical antibiotics or could be due to the excess moisture content in the external auditory canal.

What Are the Symptoms of Otitis Externa?

The symptoms and signs seen in patients with otitis externa are as follows:

• Ear pain gets severe when the outerwear is pressed or tugged on. This pain can radiate to the whole side of the face of the affected ear.

• Itching in the ear.

• Foul smell from the ear.

• Drainage of yellow or yellowish-green pus from the affected ear.

• Feeling pressure building up in the ear.

• Blocked ear.

• Decreased hearing or temporary hearing in the affected ear.

• Mild fever.

• Redness or swelling around the ear.

• Tinnitus (ringing in the ear).

The symptoms are usually seen in the affected ear only; bilateral occurrence of symptoms is rare. The symptoms of otitis externa are similar to many other medical conditions affecting the ear. So always consult a doctor if a child has these symptoms.

How Is Otitis Externa Diagnosed?

Otitis externa is diagnosed by taking a complete medical history and followed by a physical examination. An otoscope, which is a lighted instrument, may be used to see inside the ear and which will help in the diagnosis of the condition. This will also help the doctor to understand if the infection has spread to affect the middle ear resulting in a condition called otitis media.

Sometimes for further investigation, a sample of the draining pus may be taken and sent for a culture test to identify the specific organism causing the infection, and the treatment will be modified depending on it.

What Is the Organism-Specific Therapy for Otitis Externa?

The organism-specific therapy involves a treatment that is specifically modified to target the specific organism causing the condition. The specific therapy for each organism is mentioned below.

1. Pseudomonas Aeruginosa and Staphylococcus Aureus

Any one of the following regimen:

• Acetic acid 2 percent with or without Hydrocortisone otic four drops in the affected ear thrice daily for seven days.

• Ciprofloxacin or Dexamethasone otic four drops in the affected ear twice for seven days.

• Neomycin, Polymyxin, Bor hydrocortisone otic four drops in the affected ear thrice for ten days.

• Ofloxacin 0.3 percent otic ten drops in the affected ear once daily for seven days.

2. Pseudomonas Aeruginosa (Malignant Otitis Externa)

Any one of the following regimen:

• Ciprofloxacin 400 mg IV every 12 hourly or 750 mg by mouth every 12 hourly for four to six weeks.

• Cefepime 2 g IV 12 hourly for four to six weeks.

• Piperacillin or tazobactam 3.375 mg IV six hourly for four to six weeks.

• Imipenem 0.5 g IV six hourly for four to six weeks.

• Meropenem 1 g IV eight hourly for four to six weeks.

• Ceftazidime 2 g IV eight hourly for four to six week.

3. Fungi (Candida Albicans, Aspergillus Niger)

Any one of the following regimen:

• Clotrimazole 1 percent otic solution four drops in the affected ear four times a day for seven days.

• Fluconazole 200 mg for one dose, then 100 mg for three to five days.

How Is Otitis Externa Treated?

The treatment of otitis externa is done based on the following:

• Age of the patient.

• The extent of the condition.

• The severity of the disease.

The treatment will include the following:

• Antibiotic ear drops.

• Corticosteroid ear drops might be prescribed to reduce the inflammation and itching from the condition.

• Pain killers.

Sometimes, the ear canal might have got narrowed, which will block the ear drop delivery to the site of the infection from the inflammation. In such cases, the gauze is placed inside the ear canal, which will help to deliver the eardrops. Ear drops are given for a period of one to two weeks. In these conditions, oral antibiotics are used for treatment very rarely.

What Can Be Done to Prevent Otitis Externa?

• Keep the ear canals dry as possible.

• Turn the head from side to side after getting out of the water as this will help the water to drain out from the ear canal.

• Avoid putting foreign objects inside the ear, like pens, pencils, hair clips, paper clips, etc.

• Avoid swimming in polluted water bodies.

• Do not swallow water while swimming.

Conclusion

Otitis externa is a type of ear infection that can cause severe pain in the ear and can affect the day-to-day performance of the affected person. In order to avoid getting such diseases, always take precautions while getting into the water bodies. In case there are any symptoms, always consult an ENT (ear, nose, and throat) specialist for treatment.