What is it about ?
The external auditory canal extends from the pinna of the ear to the eardrum.
Inflammation in this area can be acute or chronic. It is believed that a disturbance of the local acidic environment may be the source of the problem. Earwax is normally acidic and protects against bacteria. Soap and shampoo can suppress this effect.
Other risk factors are a hot and humid environment, “dirty” water (swimming), obstruction of the ear (for example by earplugs or a hearing aid), scratching in the ear , ear cleaning (cotton swabs), middle ear infection, contact allergy, psoriasis, eczema, diabetes, and too narrow an ear canal. A tumor of the external ear canal may explain the problem, although this is rare.
What is its frequency?
Each year, the general practitioner diagnoses an acute infection of the outer ear (pinna and external auditory canal) in about 14 people in 1000. The condition occurs mainly in summer, because it is during this season that ‘we swim the most. The chronic form is less common.
How to recognize it?
Acute inflammation of the external auditory canal develops quite quickly, over a few hours to a few days. The main symptoms are ear pain and itching. Purulent fluid may flow from the ear. The external ear canal may also be red and swollen, and sometimes covered with small scales. Sometimes we see a small abscess on the outer edge. The person also hears less well.
Chronic inflammation of the external auditory canal extends over a few weeks or even months. The main symptoms are itching, the pain being almost absent. The skin peels and is thicker. Usually there is no discharge from the ear, and if there is, it is rather clear.
How is the diagnosis made?
To rule out a middle ear infection, the doctor inspects the pinna and examines the ear canal and eardrum with the otoscope. In the event of infection with a fungus, the ear canal appears to have mold or is covered with a gray-black veil. If there is pus, the doctor will take a sample with a cotton swab for further laboratory tests. If he suspects psoriasis, he also checks the skin on the elbow or scalp. In a completely normal examination, he finally examines other possible causes of ear pain (for example a throat or jaw joint disease).
What can you do ?
The ear canal cleans itself. You should not quibble in your ears or clean them with a cotton swab. As the ear canal is narrower inward, you would push earwax and dirt deeper into the ear.
Swimmers can use protective earplugs or cotton pads with petroleum jelly.
It is best to shower or wash your hair while leaning forward, so that no water can get into the ear canal. Thoroughly dry the pinna and the entrance to the ear canal.
You can have your hearing aid adjusted so that the ear canal is better ventilated.
What can your doctor do?
Thorough cleaning of the ear canal, usually with lukewarm water or saline solution, is the basis of treatment. Then, cortisone-based drops are applied to the ear. Paracetamol or an anti-inflammatory can act as a painkiller.
If you still have symptoms three weeks after starting treatment, the doctor will check your ear for fungi, yeasts, and bacteria. If necessary, he prescribes preparations against fungi or yeasts (antimycotics) or against bacteria (antibiotics).
Any triggering factors are dealt with. If you suspect a contact allergy, you can first check whether avoiding the possible cause is having an effect. The doctor can also refer you to a specialist for an allergic examination.
In case of fever, general feeling of discomfort, or extent of inflammation in the pinna or the skin surrounding the ear, drops and antibiotics are necessary. An abscess is incised.
The doctor will refer you to a specialist in the following cases: unfavorable course, treatment failure, suspected malignancy, diabetes and symptoms on one side in an elderly person.
Want to know more?
- Paracetamol – CBIP – Belgian Center for Pharmacotherapeutic Information
- Non-steroidal anti-inflammatory drugs – CBIP – Belgian Center for Pharmacotherapeutic Information
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