Otitis Externa is also associated with high humidity, warmer temperatures, swimming, local trauma, and hearing aid use or hearing protector use.

Symptoms of otitis externa

Initial symptoms of otitis externa (mild) may be:

• itchiness and/or a white watery discharge (otorrhea) - usually an indication of a fungal infection. The discharge may dry overnight around the outside of the ear. There is usually little or no hearing loss. This type of otitis externa is also called swimmer's ear. It is usually indicated by continual itching of the outer ear. The white watery discharge is the normal detritus of active fungal growth in the damp parts of the outer ear.
• pus-like discharge - can indicate a bacterial or viral infection. There is no easy way to check if the affected area is caused by a bacterial or viral infection without taking a swab and having it tested in a lab. See your doctor. With either a bacterial or viral cause there will be more redness and swollen features on the outer ear and ear canal, and as shown below, a swollen ear drum. This condition may also indicate otitis media (middle ear infection).

 

• Other indicators of the bacterial/viral infection type are headaches and continual draining from the Eustachian tube to the back of the throat, which does not taste very nice. A bacterial or viral infection usually will not cause a whitish discharge from the ear, but may cause a pus-like discharge from the middle/inner ear (otitis media).

Treatments for Otitis Externa

General Intermediary treatment

• Apply warm, moist compresses, heating pads, or hot water bottles to the ear to relieve inflammation and pain
• Take ONE ibuprofin or aspirin every 4 hours for pain (no more)
• Have someone gently clean the draining ear

Treatment for Fungal Causes of Otitis Externa (a.k.a Swimmer's Ear)

Note: This remedy should only be used if it known that there is no opening of the eardrum (i.e. no burst eardrum or continuous pus discharge from the middle/inner ear)

Home remedy: A known effective home remedy for "swimmer's ear" (the fungal infection kind) is to make the canal environment slightly acidic. Obtain some powdered boric acid and a pint of ethyl alcohol (not methyl alcohol which is the more common kind) from your local pharmacy. Take a large pinch of the boric acid and drop into into the 1 pint of ethyl alcohol. After shaking well, take an eyedropper full of the mixture and fill the ear canal with the mixture. Let sit for a minute, then turn the head to drain out. Do it one more time and wipe any excess liquid off. Do this three time a day for 5 days. In the mornings, you will notice the dried mixture will cake. Just wipe off with a damp cloth.

Another home remedy is to use apple cider vinegar instead of the boric acid solution. Use the same procedures as above.

Why do these home remedies work? Fungal infections thrive in damp dark environments where the pH is above 7.0 (Basic). Both the above treatments drop the pH below 7.0 to about 6.2 - 6.8 making the environment acidic. Fungus cannot live or thrive in an acidic environment where the pH is below 7.0

Daily regimen: While you have a fungal ear infection, UNDER NO CIRCUMSTANCES LET WATER OR SOAP INTO THE EAR WHEN YOU TAKE A SHOWER. After a week you should be fine. If it does not clear up in a week, see your doctor. Your doctor may prescribe a silver nitrate gel which is known to be effective against stubborn chronic fungal otitis externa.

Note: If you are a swimmer and want to continue swimming with the infection present, before each swim, dip a small amount of cotton in the boric acid solution (or apple cider vinegar) and plug up the ear. After each swim pull out the cotton and treat each ear as above. Do not use ear plugs as they will irritate the ear canal. IF YOU ARE A DIVER, DO NOT DIVE UNTIL THE INFECTION CLEARS UP  ( 7-10 days).

Treatment for Bacterial Causes of Otitis Externa:

Note: This remedy should only be used if it known that there is no opening of the eardrum (i.e. no burst eardrum or continuous pus discharge from the middle/inner ear)

Over The Counter (OTC) combined topical antibiotics may do the job, but not always. Take a Q-tip (cotton bud) and squeeze a liberal amount of the antibiotic gel onto the end and carefully coat the inside of the outer ear. Do it twice a day for 5 days. If the condition persists, see a doctor. Do not go more than 1/2" into the ear canal when applying the salve!

• Otitis externa (bacterial) is treated with antibiotic drops and pills.
• The ear canal can also be treated in the doctor's office with a topical antifungal preparations.

Rarer causes that mimic otitis externa are:

Aural polyps

Aural polyps are growths that occur within the outer ear. They look like bumps or pimples. If left untreated they produce a smelly pus and, perhaps, blood-streaked discharge. If left to grow, they can completely block the ear canal causing a hearing loss.

Contact Dermatitis (allergies)

A common cause of chronic otitis externa is allergies, specifically contact dermatitis from foreign objects - earrings, cosmetics, shampoos, and hearing aids or ear plugs. Usually this type of allergy causes just itching with no discharge. The only way to cure the dermatitis reaction is by a process of elimination. List the items that have come in contact with the ear and ear canal over the past week and eliminate all of them if you can. Then, one by one, every 4 days, add one back into contact. The 4 days will allow any allergic reaction to re-occur. If the reaction does occur within the 4 day period, then you know the culprit and stop using it.

Food Allergies

Food allergies are another possible cause of irritation in the ear canal as with any other area on the skin and the hardest to track down. Again, it is sometimes a process of elimination. The best thing to do if there is continual re-occurrences of otitis externa is to visit an allergist and get a full battery of tests of common foods (if possible). However, allergists often have few tests for food allergies and usually give the same advice as we have given with contact dermatitis. Start eliminating foods one at a time (of course, without starving :))

Eczema or Psoriasis

If you suffer from eczema or psoriasis, it is possible for an outbreak to occur in the ear canal. There is no easy cure for this condition and the only treatment in the narrow ear canal will be warm oil or some other liquid to keep the skin soft and hope the natural action of the ear and ear wax, sloughs off the dead skin cells.

Basilar skull fracture (BSF).

A BSF cause is quite self-evident: A fall or blunt trauma to the side of the head may produce secondary symptoms and drainage out of the ear.  With a basilar skull fracture and outer ear discharge, a discharge from the ear (otorrhea) may be clear and watery. This is different than the whitish color of a discharge consistent with a fungal infection.  If the discharge is tested in the lab, and glucose is found, it means that the liquid surrounding the brain - cerebrospinal fluid (CSF) is leaking through the aural (ear) system. If you have had a serious head accident in the past 2 weeks, this condition is extremely serious and life-threatening and you should go to the emergency room immediately.

Symptoms of a serious bsf may include a bloody discharge from a burst ear drum. If the ear drum has not yet been broken, blood may accumulate in the middle ear cavity and either put pressure on the ear drum or drain through the Eustachian tube into the throat. If you have had the head trauma and you are coughing up blood, immediately go to the emergency room.

Other serious bsf symptoms are: cranial nerve palsies (tremors and twitching of the facial muscles), passing out (unconsciousness), ear aches and headaches.

Perforated eardrums (burst eardrum)

Perforated eardrums from internal causes (pressure pushing out on the ear drum) are caused by middle ear infections (viral or bacterial - otitis media) In most cases, a burst eardrum from a middle ear infection will heal on its own within about two months. However, if an item such as cotton bud, pencil, or sharp object caused the burst eardrum, a trip to your family doctor is mandatory. Your doctor will probably clean the ear carefully give you an antibiotic shot and antibiotic ear drops, then prescribe antibiotic tablets for a 10 day regimen. In severe cases, you may be referred to an ENT specialist (Ear, nose, Throat specialist).

More detailed information on a Burst eardrum

Common Problems of the middle ear   

Common terms for the bones of the middle ear (Ossicles) are: Stirrup (Stapes), Hammer (Malleus). Anvil (Incus)


Otitis media (Middle Ear Infection)

Otitis media is an infection or inflammation of the middle ear usually caused by a viral or bacterial infection.

Symptoms
Some of the symptoms of middle ear infection include:

• Earache
• Headache
• Fever
• Discharge from the ear
• Mild deafness
• Difficulties in sleeping
• Loss of appetite.

Causes: The causes of middle ear infection can be:

• A progressive head cold
• A viral sinus infection that spreads
• An otitis externa infection left too long that spreads to the inner ear
• Blowing the nose too hard, forcing sinal or Eustachian material into the middle ear.
• An opportunistic infection entering through a perforated eardrum

Treatment for Otitis Media

Mild bacterial infections clear up by themselves in a matter of days. Over-the-counter painkillers can help alleviate the pain. Warm olive oil dripped in the ear can also soothe the pain as long as there is no ruptured eardrum. Repeat every few hours.

In more severe cases, antibiotics might be needed which usually includes an initial antibiotic shot, antibiotic pills and ear drops.

In many cases of middle ear infection, the Eustachian tube is blocked and can cause or at least contributes to a middle ear infection. (See also Glue Ear, below). A Eustachian tube can become blocked from any combination of the following:

• The body's inflammation reaction to an infection, swelling the Eustachian tube to where it closes completely.

• A contributing factor can be the discharge of the dead bacteria and dead lymphocytes in the lymphatic fluid from the middle ear. The lymphatic system contains the white blood cells or lymphocytes which are the body's defense against foreign objects such as bacteria. When the white blood cells kill bacteria, the lymphatic fluid becomes pus-like. Pus is made up of dead white blood cells and dead bacteria. This discharge from the middle ear can irritate the Eustachian tube causing it to close.

A blocked Eustachian tube is what causes the pain of a middle ear infection. Pus builds up in the inner ear cavity with no where to go, putting pressure on the inner ear and the ear drum. If left without treatment, pressure in the middle ear cavity can be so great that it bursts the ear drum. The initial excruciating pain of a burst eardrum is immediately compensated for by pain reduction from the release of pressure. Whereas, prior to the burst eardrum, sleep was impossible, the pain relief from the pressure reduction allows the sufferer to finally sleep. If the middle ear infection is cured, the ruptured ear drum usually heals on its own, although sometimes surgery (tympanoplasty) is indicated if the rupture is extremely large.

Otitis Media Variants