Treatment patterns for otitis externa.

Abstract

BACKGROUND:

Although otitis externa is a common and painful infection of the outer ear canal, there is little specific information available regarding current treatment patterns in the United States. We wanted to examine treatment patterns for otitis externa.

METHODS:

Data were analyzed from the 1993 National Ambulatory Medical Care Survey (NAMCS) and the 1993 National Hospital Ambulatory Medical Care Survey (NHAMCS) for adults and children treated for otitis externa. Data analyses included the reasons for physician visits, concomitant diagnoses, types of physicians seen, sources of payment, medical procedures administered, drugs prescribed, and patient disposition following a physician visit.

RESULTS:

Study results suggested that treatment patterns differ substantially for adults and children, as well as by physician specialty. Although otitis externa is frequently painful, few cases are classified as severe, and the data indicated that less than 20 percent of patients have concomitant diagnoses treatable by medication. Nevertheless, 40 percent of patients received both topical and systemic medication, and many of the oral antibiotics prescribed are not active against Staphylococcus aureus or Pseudomonas aeruginosa, the most common bacterial pathogens in otitis externa.

CONCLUSIONS:

Appropriate treatment of localized otitis externa with topical antibiotics should eliminate the need for systemic medications. Addition of systemic medications can unnecessarily increase treatment costs and the likelihood of side effects, and could reduce the likelihood of patient compliance.

Symptoms of Swimmer's ear / Otitis externa

According to the Centers for Disease Control and Prevention typical symptoms include

• Persistent itchiness inside the ear

• Inflammation of the ear

• Redness of the ear

• Pain on touching the ear or ear lobe and

• Formation of pus on the surface of the ear

While swimmers ear can affect anyone, the painful problem is more common in children.

Causes of Swimmer's ear / Otitis externa

Almost all cases of swimmer's ear are caused by bacterial infection and very rarely are caused by fungus or virus. Bacteria found in water and soil is primarily responsible for it. 

Human ear is designed in such a way that it keeps bacteria and foreign objects out. The ear produces a waxy substance called cerumen that prevent water from entering the ear and also ensures foreign material like dirt and dead skin is prevented from finding a way into the ear. Ultimately cerumen is forced out of the ear in the form of what we popularly call as ear wax. Human ear also slopes outward slightly to enable water to flow out. However, during a swim the intake of water can be too heavy for the ear to expel and some amount of water remain. The moisture trapped in the ear makes it good place for bacteria to grow.

In certain cases if there is a scratch or cut in your ear canal region and your skin is exposed, it may lead to bacterial growth. . Sometimes certain hair products or jewelry can also cause such infection.

Risk factors for Swimmer's ear / Otitis externa

Risk for a swimmer’s ear increases when swimming in untreated water like lakes and canals, which have high amount of bacterial growth. The risk of the infection is also high in children as their narrow ear canal prevents water from flowing out. Cleaning your ear with sharp objects also increases the change of rupturing the skin and increasing chances of bacterial infection.

Diagnosis of Swimmer's ear / Otitis externa

According to NewYork-Presbyterian Hospital swimmer's ear is generally diagnosed with a complete medical history and physical examination of the patient. A device called the otoscope maybe used by the doctor which allows the ear canal to be lighted up to ensure proper visibility. This enables easier examination of the ear, says the hospital. An examination of the ear is important as it allows the doctor determine the scope of the infection and the severity of the condition. A doctor may also want to take a culture of the drainage from the ear to help determine proper treatment.

Treatment of Swimmer's ear / Otitis externa

Swimmer’s ear generally heals itself. Most infections get treated on it’s own by keeping the ear dry. However, in certain cases treatment of the infected area becomes necessary. A doctor may recommend ear solution to take care of the infection. These solutions generally contain acidifying and drying agents or both. In some cases steroids also prove beneficial in treatment of swimmer’s ear. 

Ear drops that have antibacterial or antifungal properties are also used. Topical antibiotic solutions such as aminoglycoside, polymyxin or fluoroquinolone are effective in treating swimmer’s ear. For medication to be effective it is important to keep the area clean and remove debris like wax, dead skin, and pus from the ear canal. Sometimes an ear wick is used in cases when medication cannot reach the innermost part of the infection due to ear canal getting blocked due to infection.

Corticosteroids may also be using during this time to reduce itching and inflammation. In cases of fungal infection, antifungal solutions are used for treatment.

Prevention of Swimmer's ear / Otitis externa

According to NHS UK if you are a regular swimmer, it is good to get a swimming cap to protect the ears and prevent large amounts of water from entering the ear. Make sure that you ear canals are clear of water after swimming, bathing or showering.