Otitis externa, also known as swimmer's ear, is an infection of the outer ear canal caused by bacteria or fungi. It commonly affects children ages 7-12 and the elderly. Symptoms include ear pain, itching, discharge and temporary hearing loss. Diagnosis is made through physical exam, microscopy and culture of discharge. Treatment focuses on removing debris, using antibiotic/antifungal ear drops, and dry ear precautions to prevent recurrence, especially in high-risk groups like diabetics who are prone to the more serious malignant otitis externa infection.

1. PARUL INSTITUTE OF NURSING

2. OTITIS EXTERNA
• It is an infection of the outer opening of the
ear and ear canal.
• Also referred to as swimmer’s ear or External
otitis. It results from the exposure of moisture.
• It occurs most commonly among children
between the ages of seven and twelve and
among the elderly.

4. CLASSIFICATION
Acute: Lasts less
than 6 weeks.
• Typically due to
bacterial infection
Chronic: Lasts more
than 3 months.
• Due to Allergies or
autoimmune
diseases.

5. ETIOLOGY
• Swimming in the contaminated water.
• Objects in ear( cotton swabs or other small
objects to clear the ear canal, hearing aid, ear
plugs).
• Infections: Staphylococcus aerus, P.
Auruginosa, Candida albicans.
• Other trauma

6. RISK FACTORS
Diabetes Psoriasis.
Atopic
dermatitis
Eczema Asthma HIV

7. PATHOPHYSIOLOGY
•

8. CLINICAL MENIFESTATIONS
• Red, swollen ear canal
• Four discharge from ear.
• Itchiness.
• Fever
• Ear pain( Pain worsened when external ear is
touched).
• Temporary conductive loss.
• Severe cases : Ear canal narrowed through
exudates.

9. DIAGNOSTIC EVALUATION
• History collection
• Physical examination: Redness in the ear,
fullness of ear.
• Lab test: Gram staining and culture of
discharge.
• Imaging test: CT scan, MRI of head,
radionuclide scan.

10. MANGEMENT
• The goal of treatment is to stop the infection and allow
your ear canal to heal.
• Avoid getting affected ear wet.
• Remove any discharge/debris by gently swabbing outer ear
with cotton wool.
• Remove anything from affected ear which may cause an
allergic reaction such as hearing aids,earplugs,earrings.
• Debridement: the infected debris should be gently and
thoroughly removed from the canal with suction or dry
cotton swabs under adequate lighting
• Painkillers such as ibuprofen, Paracetamol.
• Burow’s solution: Mixture of aluminum sulphate and
acetic acid. It is used against the bacterial infection.

11. • Antibiotic +Corticosteroid eardrops is used.
Such as ciprofloxacin And hydrocortisone.
• Antifungal eardrops: Nystatin.
• Dry ear precautions (e.g. wearing shower cap,
avoiding swimming) are strongly advised for
both external otitis and fungal external otitis..

12. • Prevention: External otitis can be prevented
by applying a few drops of 1:1 mixture of
rubbing alcohol and vinegar just after the
swimming.

13. COMPLICATIONS
• Abscesses.
• Narrowing of ear canal
• Inflamed or perforated eardrum
• Cellulitis.
• Malignant otitis externa: Mostly occur with
person with diabetes mellitus.

14. MALIGNANT OTITIS EXTERNA
• Malignant otitis externa (MOE) also known as
necrotizing otitis externa , is an invasive
bacterial infection that involves the external
auditory canal and skull base.
• It is a complication of otitis externa that
occurs in immunocompromised patients.
• It is typically seen in elderly diabetic patients.

15. • Pseudomonas Auruginosa is causative in 95%
of cases.
• Other causative organisms such as S.aureus,
Proteus mirabilis, Klebsiella etc.
• It is treated with antipseudomonal antibiotics
• Fluoroquinolones are also given.

18. PREVENTION
• Keep ears dry
• Swim wisely
• Avoid putting foreign objects in ear
• Use caution after an ear surgery or
infection.

19. NURSING MANAGEMENT