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Chronic Otitis Externa
ALTERNATIVE NAMES:
DEFINITION: Chronic ear canal dermatitis.
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WHAT IS GOING ON IN MY BODY? The anatomy and physiology of the ear canal has already been discussed under the topic of acute otitis externa. Chronic otitis externa occurs when there is persisting trauma or inflammation to the ear canal.
WHAT ARE THE SIGNS AND SYMPTOMS? One of the most prominent symptoms that patients have is itching in the ear canal. Other symptoms include low-grade pain, flaky skin. Infrequently is there any infected drainage material, severe tenderness, or hearing loss.
WHAT ARE THE CAUSES AND RISKS? Repetitive trauma to the ear canal in the form of Qtips, bobby pins, etc. can alter the normal skin replacement pattern of the ear canal. Superficial fungal infections can also be a cause. In this particular situation, the skin of the ear canal becomes quite thick, and when peeled up, there is significant redness of the underlying skin. In certain situations there may be fruiting bodies forming on the skin of the ear canal as can be seen with any typical mold – use of Neomycin can cause a chronic inflammatory reaction similar to that caused by poison ivy. Therefore, these medications need to be used with some caution. Excessive dryness of the ear canal is also a factor.
HOW TO PREVENT THE DISEASE: If the disorder is caused by repetitive trauma, then stopping ear canal manipulation reverses it. For fungal forms of the illness, keeping the ear canal free of wax and keeping the ear canal dry will help prevent it. Avoiding Neomycin-containing agents may also be necessary.
HOW IS IT DIAGNOSED? It is diagnosed by examining the outer ear structures. Often thinning of the ear canal skin, flaky skin, or flaky, dried, yellow material is present. In fungal forms the skin of the ear canal may be thickened and can easily be removed. The underlying skin is often intensely red.
WHAT ARE THE LONG-TERM EFFECTS? The main long-term effect would be continued thickening of the skin of the ear canal to the point where the ear canal would be obliterated and hearing loss occur.
AM I PUTTING OTHERS AT RISK? No.
WHAT ARE THE TREATMENTS? For those caused by repetitive manipulation, treatment involves cessation of the ear canal trauma. Individuals with fungal forms need to have the surface of the diseased skin removed. Ointments containing antifungal and steroid medications are applied to the ear canal. For some of the other fungal forms, steroid ointments and white vinegar irrigations will often be successful. For those forms of chronic bacterial infections, then antibacterial-containing drops often restore the external canal to a normal, healthy state. If dryness is a cause, then several drops of baby oil in the ear canal will keep it more moist. For the obliterated ear canal, scarred lining must be removed and skin grafts placed to reline the bone.
WHAT ARE THE SIDE EFFECTS TO THE TREATMENTS? The main side effects would be limited to the medications employed to treat the underlying disease. The concern with ointment application into the external canal, particularly if a Q-tip is used, is perforation of the tympanic membrane.
WHAT HAPPENS AFTER TREATMENT? Most patients have their disease completely resolve after appropriate therapy. Some individuals continue to have a need for intermittent management.
HOW DO I MONITOR THE DISEASE? The disease is mostly monitored by the intensity of the symptoms. Any acute symptoms developing, such as pain, purulent drainage, or tenderness of the ear canal, should be tended to immediately by medical personnel as this might represent an acute otitis externa.
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