Otitis externa - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Acute otitis externa (AOE) is a diffuse inflammation of the external ear canal that is most commonly caused by Pseudomonas aeruginosa and Staphylococcus aureus.
Presents with rapid onset of ear pain, tenderness, itching, aural fullness, and hearing loss.
More common in children and young adults.
Fungal otitis externa is a fungal infection of the external ear caused by molds and yeasts, which presents in a similar way to acute bacterial otitis externa.
Necrotizing otitis externa infection (also called malignant otitis externa) involves skin and soft tissue of the external auditory canal and bone tissue of the temporal bone.

Quick Reference

History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Diagram of acute otitis externa
Swollen ear canal, almost completely closed due to acute otitis externa
White purulent debris can be seen at the external auditory meatus
The ear canal is narrowed, making it appear more slit-like, with white debris sitting on the canal wall

Citations

Key Articles

Rosenfeld RM, Schwartz SR, Cannon CR, et al. American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. 2014 Feb;150(1 suppl):S1-24. [Erratum in: Otolaryngol Head Neck Surg. 2014 Mar;150(3):504].[Abstract][Full Text]
Hirsch BE. Infections of the external ear. Am J Otolaryngol. 1992 May-Jun;13(3):145-55.[Abstract]
Jackson EA, Geer K. Acute otitis externa: rapid evidence review. Am Fam Physician. 2023 Feb;107(2):145-51.[Abstract]
Selesnick SH. Otitis externa: management of the recalcitrant case. Am J Otology. 1994 May;15(3):408-12.[Abstract]

Referenced Articles

1. Rosenfeld RM, Schwartz SR, Cannon CR, et al. American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. 2014 Feb;150(1 suppl):S1-24. [Erratum in: Otolaryngol Head Neck Surg. 2014 Mar;150(3):504].[Abstract][Full Text]
2. Browning GG. Aetiopathology of inflammatory conditions of the external and middle ear. In: Kerr AG, ed. Scott-Brown's Otolaryngology. Oxford, UK: Butterworth-Heinemann; 1997.
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12. Jackson EA, Geer K. Acute otitis externa: rapid evidence review. Am Fam Physician. 2023 Feb;107(2):145-51.[Abstract]
13. Selesnick SH. Otitis externa: management of the recalcitrant case. Am J Otology. 1994 May;15(3):408-12.[Abstract]
14. Roland PS, Stroman DW. Microbiology of acute otitis externa. Laryngoscope. 2002 Jul;112(7 Pt 1):1166-77.[Abstract]
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30. Kaushik V, Malik T, Saeed SR. Interventions for acute otitis externa. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD004740.[Abstract][Full Text]
31. Kantas I, Balatsouras DG, Vafiadis M, et al. The use of trichloroacetic acid in the treatment of acute external otitis. Eur Arch Otorhinolaryngol. 2007 Jan;264(1):9-14.[Abstract]
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33. van Balen FA, Smit WM, Zuithoff NP, et al. Clinical efficacy of three common treatments in acute otitis externa in primary care: randomised controlled trial. BMJ. 2003 Nov 22;327(7425):1201-5.[Abstract][Full Text]
34. Lambert IJ. A comparison of the treatment of otitis externa with "Otosporin" and aluminium acetate: a report from a services practice in Cyprus. J R Coll Gen Pract. 1981 May;31(226):291-4.[Abstract][Full Text]
35. Mösges R, Schröder T, Baues CM, et al. Dexamethasone phosphate in antibiotic ear drops for the treatment of acute bacterial otitis externa. Curr Med Res Opin. 2008 Aug;24(8):2339-47.[Abstract]
36. Pistorius B, Westberry K, Drehobl M, et al. Prospective, randomized, comparative trial of ciprofloxacin otic drops, with or without hydrocortisone, vs. polymyxin B-neomycin-hydrocortisone otic suspension in the treatment of acute diffuse otitis externa. Infect Dis Clin Pract. 1999;8:387-95.
37. Jones RN, Milazzo J, Seidlin M. Ofloxacin otic solution for treatment of otitis externa in children and adults. Arch Otolaryngol Head Neck Surg. 1997 Nov;123(11):1193-200.[Abstract]
38. Wall GM, Stroman DW, Roland PS, et al. Ciprofloxacin 0.3%/dexamethasone 0.1% sterile otic suspension for the topical treatment of ear infections: a review of the literature. Pediatr Infect Dis J. 2009 Feb;28(2):141-4.[Abstract]
39. Mösges R, Nematian-Samani M, Hellmich M, et al. A meta-analysis of the efficacy of quinolone containing otics in comparison to antibiotic-steroid combination drugs in the local treatment of otitis externa. Curr Med Res Opin. 2011 Oct;27(10):2053-60.[Abstract]
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41. Rahman A, Rizwan S, Waycaster C, et al. Pooled analysis of two clinical trials comparing the clinical outcomes of topical ciprofloxacin/dexamethasone otic suspension and polymyxin B/neomycin/hydrocortisone otic suspension for the treatment of acute otitis externa in adults and children. Clin Ther. 2007 Sep;29(9):1950-6.[Abstract]
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48. US Food and Drug Administration. FDA drug safety communication: FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. July 2018 [internet publication].[Full Text]
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51. Bernstein JM, Holland NJ, Porter GC, et al. Resistance of Pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa. J Laryngol Otol. 2007 Feb;121(2):118-23.[Abstract]
52. Sreepada GS, Kwartler JA. Skull base osteomyelitis secondary to malignant otitis externa. Curr Opin Otolaryngol Head Neck Surg. 2003 Oct;11(5):316-23.[Abstract]
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