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Otitis externa or outer ear infection is an entity which most people are aware of because they might have had the infection themselves or a close relative has had it.  It will then be evident that this is a condition that produces a severe amount of discomfort and pain and if not treated adequately and judiciously, it can become quite a serious problem, spreading to the surrounding tissues.

The patient presents with initially mild pain or irritation in the ear.  This is then treated by possibly cleaning the ear with a cotton bud which in most cases aggravates the condition. Patients then take pain medication or Analgesic which masks the symptoms.  Eventually they decide to go to their General Practitioner.  Usually at that stage the pain will be quite severe and the external ear will be very swollen or completely blocked.

The diagnostic symptom of otitis externa and differentiating it from otitis media is that, if pressure is placed on the entrance to the ear, this will be extremely painful.

Treatment consists of the following:

  • Careful cleaning of the outer ear to confirm the diagnosis and placement of antibiotic drops into the ear. Should the ear be so swollen that it is impossible to get the drops into the ear, the doctor will push a gauze into the ear and then saturate it with the antibiotics.  This may be left in for twenty four hours.
  • It is also imperative that a broad spectrum antibiotic be given and sufficient pain medication consisting of a possible Paracetamol and anti-inflammatory combination like Myprodol.

If the condition does not recover dramatically, Specialist intervention is suggested.  The Ear, Nose and Throat Specialist will, under the microscope, try to clean the ear as best he can with a suctioning apparatus.  A tight plug with an antibiotic and cortisone mixed ointment will be placed in the external ear.

High doses of cortisone will be given as this reduces the swelling and then enables the ear to ventilate thereafter.

The doctor will also most likely do an X-ray to see if the infection is limited to the outer ear or whether the middle ear and mastoid areas are involved as well.

Usually the condition improves within a day or two and after five or six days the patient should have recovered completely.  If this is not the case or if the condition deteriorates rapidly, one should consider a condition called malignant otitis externa.  This is mostly almost exclusively found in diabetic patients whose diabetes is not well controlled and the offending organism is usually Pseudomonas Aeruginosa.  This requires hospitalisation with very specific high doses of antibiotics.  Close monitoring of the condition and in some instances lifesaving surgery can be performed.


Otitis externa or outer ear infections are a common condition, especially in people who have been swimming in contaminated water.

They are usually quite amenable to conservative treatment and will clear up, however, do not neglect the condition in a child or in an adult if it does not follow the course which you think it should.