Outer Ear Infections

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Please note that the following is a general guideline only. For a full assessment, exclusion of any other underlying cause for your symptoms and an individualised treatment approach, you will need to be seen by a qualified specialist.

What is an outer ear infection?

Outer ear infections extend from the entrance to the ear canal to the ear drum. The infection usually does not spread any further unless there is a defect in the ear drum, in which case it may spread to the middle ear.

How do ears protect them selves? 

Ear canal is a moist dark environment where bacteria and fungi may thrive. However ears keep them from getting infected due to the following reasons.

Oils in the ear canal

Acidity of the ear wax

Anti bacterial material in ear wax

Rich blood supply of the ear canal

Natural shedding of the ear skin outwards

What causes ear infections ?

Anything that disrupts the above
Use of cotton buds due to local trauma, and pushing wax against the drum
Allowing dirty water in to the ears
Eczema of the ear canals-affects the natural oils production etc
Medical conditions as Diabetes
Excessive use of ear drops: puts ear's natural flora out of balance

What different types of outer infections are there?

1 Rapid onset painful bacterial type

2 Fungal Types 

3 Chronic type: Dermatitis and fungal infections

4 Rare type which spreads to the skull bones: in immune compromised people

Note white fluff: a fungus

Wick helps deliver drops: must be soaked.

       

What are the clinical symptoms? 

Acute otitis externa:     is painful, short duration
Fungal otitis externa:   is not as painful, blocked ear canal 
Chronic otitis externa:   is not painful, itchy can have secondary acute bacterial infection 
Malignant OE:   Immune compromised mostly diabetic, deep seeded ear pain

How will this be treated? 

Through ear suction first  
Thereafter a powder may be put in or drops may be given

If swollen and very painful: may need an ear wick insertion. Wick is a sponge which soaks drops and delivers to the ear canal
If any suggestion of dermatitis: may need longer term once to twice a weekly steroid ear drops. 

Usually oral antibiotics are not necessary, unless a severe form of ear infection
Must keep the water out of the ears

When can I allow water in? 

This when your ear settles and starts producing healthy wax again. This may take months. Once safe your ear surgeon will notify you. Some who have forms of dermatitis may never be able to safely allow water in to their ears. 

What needs to be done by the patient?

Do not wear hearing aids

If you must wear them minimise the time of use and clean them afterwards.

Keep the ears dry

Use cotton wool and make in to a ball. Cover it with Vaseline to make it water proof. Use this to over your affected ear when showering. No water should get in. cotton wool should remain dry. Alternately you may use blue tac if safe to use, but do not push it too far in to the ear canals.

Dry your ears

If water gets in by accident, use a hair dryer at an arms length to blow some warm air in gently in to the ear. 

Treatment

This is usually in the form of powder instilled by your surgeon. Some have anti fungal properties and others antibacterial properties as well as steroids to reduce swelling. The particles stick to the affected ear and deliver continuous medication. At times you may be given additional steroid containing drops to use at home.

Follow up

Usually you will be seen at least once more for another suction and to ensure that no debris remains. Surgeon will then determine if you need to be seen longer term.