A B C D E F G H I J K L M N O P R S T U V W

OTITIS EXTERNA - WAX

What is Otitis Externa ?

Wax and otitis externa both occur in the outer ear or ear canal. Wax (cerumen) is produced by so-called ceruminous glands in the outer part of the external ear canal. Wax may block the ear, causing discomfort and deafness. Otitis externa is an inflammation of the skin of the external ear canal. This produces itching, followed by pain in the ear and discharge. In severe cases, the patient feels unwell and the infection may spread to surrounding tissues.

How does Otitis Externa occur ?

Wax is formed by a particular type of gland which elsewhere in the body produces sweat. The wax is thought to have a protective effect on the skin. Otitis externa may be the result of the allergy or infection or a combination of both.

Why does Otitis Externa occur ?

Normally wax is not produced in great amounts and comes out of the ear by itself. Usually it does this in the form of small flakes or pieces. Sometimes this process does not seem to work well. Wax then builds up in the ear. Excessive use of soap and water in the ears may stimulate wax production. On the other hand, excessive cleaning of the ear may remove too much wax. A thin layer of wax on the skin probably protects it against infection. Without it, otitis externa can develop. Sometimes patients with the skin condition of eczema or psoriasis also have the condition in the outer ear canals. Psoriasis may mimic otitis externa while eczema is actually a type of otitis externa. If the ear canal is subjected to hot and humid condition, or is eczematous, it is more likely to become infected. In fact, one of the names for otitis externa is tropical ear because tropical conditions make infection more common. Even mild damage to the ear canal with a fingernail or cotton wool bud may trigger the condition. Sometimes an allergic reaction to eardrops or cosmetics may lead to otitis externa. The problem germs (bacterium or fungus) are normally present in the ear canal. The inflammation of the ear canal, however it is produced, allows these germs to get into the surface of the skin and cause the infection. Infected secretions of chronic middle ear disease may also be the source of infection. Frequently in this modern age of pollution, swimming is the cause.

Treatment Involved for Otitis Externa

The inside of the ear should be gently cleaned with a large piece of cotton wool. Avoid using cotton wool buds and don't try to get the wax out with matchsticks or other implements. If wax still collects in the ear, it is worth using olive oil drops to soften the wax. Soft wax may come out by itself and is easier for the doctor to remove. Olive oil is bland and will not cause a reaction in the skin. It is probably preferable to other over-the-counter drops. Do not use any drops to soften or remove wax if a perforated ear drum is present . If wax is blocking the ear, the doctor will try to remove it by syringing. The syringing is done with water at body temperature and should not be painful or cause giddiness. If an abnormal ear drum is present, and especially a perforation, then the ear should not be syringed: if the general practitioner cannot remove the wax, referral to a specialist may be necessary. Proper care of the ear will help avoid otitis externa. If the ear itches, do not scratch. Consult your doctor who may give treatment to stop the itching. Mild cases with little pain or discharge will probably respond quickly to treatment with drops.

More severe cases or those who do not respond quickly to treatment are usually referred to a specialist. Otitis externa produces a discharge in the ear canal which may be watery at first and then yellow or green. The discharge, together with wax and any swelling in the canal skin, will block the ear. This blockage may result in deafness and will also prevent the treatment from working. The skin of the ear canal needs to be clean before drops can work properly. This cleaning or aural toilet is usually done mechanically by hand and is a skilled specialist technique. The specialist will use small pieces of cotton wool on a metal wool carrier or wax scoops. In appropriate cases suction will be used, often under a microscope. All these procedures require the cooperation of the patient. Sometimes, if it is too difficult or uncomfortable, the aural toilet and suction may be done under a general anaesthetic. This is usually done as a day case but severe otitis externa may need inpatient care. Usually treatment consists of aural toilet and use of drops. These drops contain antibiotics and steroids (cortisone-like drugs). Sometimes antiseptic and antifungal drops are used. In very swollen ears, it may be helpful to place a small gauze wick in the narrow canal. This can then be kept moist with suitable drops. Laboratory culture of the discharge from the ear will help identify the germ which is causing the infection. Often the specialist can recognize the types of infection by the appearance of the ear. If the infection has spread to the surrounding tissues, then antibiotics will prescribed by mouth. In certain severe cases, the antibiotics may need to be given by injection into a vein. Troublesome cases need to have some simple tests to exclude abnormal blood conditions and diabetes. These conditions make infections more likely to persist or recur.

After Treatment for Otitis Externa

Prevention is better than cure. Avoid soap or water in the ears. Any recurrence of otitis externa needs to be treated early. Delay may result in infection which is hard to get rid of.

If Otitis Externa is Left Untreated

Infections of the outer ear canal, if untreated, are more likely to lead to chronic otitis externa. This causes thickening of the canal skin which then becomes very difficult to keep clean. It can lead to complete closure of the ear canal.