Otitis Externa (Swimmer’s Ear)

What is otitis externa?

Otitis externa, commonly known as swimmer’s ear, is an infection involving the skin of the external ear canal. This is different from otitis media (middle ear infection) where the infection is behind the eardrum. Otitis externa leads to swelling of the ear canal skin and is frequently associated with severe pain as well as ear blockage.

How is otitis externa diagnosed?

Otitis externa typically leads to severe tenderness of the ear canal, which can be detected by pulling on the earlobe. Physical examination by Dr. Lieberman reveals a tender, swollen ear canal, frequently filled with infected debris. Frequently the ear canal may be entirely swollen shut.

What causes otitis externa?

With otitis externa, bacteria or sometimes fungus penetrates the skin of the ear canal causing inflammation. Pseudomonas Aeruginosa is the most common bacterial agent to cause this infection. Risks factors for the development of otitis externa include exposure to water, use of Q-tips, and pre-existing skin conditions of the ear canal. Water softens the skin barrier, allowing organisms to penetrate and cause infection. Q-tips remove the protective layer of wax in the ear canal and can create tiny abrasions that allow infections to start. Skin conditions, such as eczema, also lead to a breakdown in the skin barrier, promoting the start of infection.

How is otitis externa prevented?

The most important steps to prevent otitis externa include keeping the ears dry and avoiding the use of Q-tips. For individuals (e.g. swimmers) who are in the water frequently,, the number of infections can be decreased by using drops of a ½ alcohol and ½ white vinegar solution in the ear canal. These drops will help to evaporate the moisture.

How is otitis externa treated?

The primary treatment for otitis externa is topical antibiotic drops placed in the ear canal. (After an infection has started, the alcohol and vinegar drops are not effective and will only cause burning and pain!) The ear doctor may need to clean infected debris from the ear canal to speed healing. Also, if the ear canal is too swollen to allow drops to be placed, your doctor may need to place a small sponge or wick in the ear canal to draw the drops past the obstruction. Oral antibiotics may be necessary for particularly severe infections.

Otitis Media (Infection of the Middle Ear Space)

What is otitis media?

Otitis media is essentially an infection of the middle ear space. This condition occurs very frequently in children and less commonly in adults. The otitis media typically results from Eustachian tube dysfunction, which leads to blockage of the natural drainage pathway from the ear to the back of the nasal airway. Eustachian tube dysfunction is very common in children, and is likely worsened by viral infections such as the common cold and possibly by nasal allergies. The otitis media typically occurs in phases. The initial inflammatory infection is called acute otitis media, and can cause pain and hearing loss. Once the acute inflammation has subsided, the middle ear fluid may drain in a short time, or the fluid may be retained, leading to otitis media with effusion (serous otitis media). This fluid collection can remain for several months in some cases, but does not typically cause pain. This condition can cause significant conductive hearing loss.

How is otitis media treated?

Most cases of acute otitis media resolve without antibiotic treatment, but some require antibiotic treatment and analgesics. Rare cases can progress to more serious infections of the mastoid or brain. Serous otitis media can be observed for some time, but surgical drainage may be considered if there is a prolonged duration of hearing loss. Ventilation tubes (pressure equalization tubes) can be placed for cases of multiply recurrent acute otitis media or long duration of serous otitis media with hearing

Myringotomy and Tube Placement

In adults, the ventilation tube can typically be placed in the office under local anesthesia. In children, the procedure is performed as an outpatient surgery that takes a few minutes. The surgery is performed through the ear canal. Some children benefit from adenoidectomy if multiple sets of ventilation tubes have been needed in the past.

How the Surgery Works

The ventilation tube provides a secondary path of middle ear ventilation that helps the middle ear stay clear of retained fluids. It is the most effective method of keeping fluid from accumulating in the middle ear.

After Surgery Care

Keep the ears dry for 3 full days after the tubes are inserted. After the 3 days, there are no restrictions with respect to getting the ears wet as Dr. Lieberman always uses waterproof tubes. The tubes usually come out on their own within a year.