Otitis Externa (Swimmer’s Ear), Acute

Presentation

In acute otitis externa (AOE), the patient complains of ear pain, which is always uncomfortable and sometimes unbearable, often accompanied by drainage and a blocked sensation, decreased hearing, and sometimes fever. When the condition is mild or chronic, there may be itching rather than pain. Pulling on the auricle ( Fig. 35.1 ) or pushing on the tragus of the ear classically causes increased pain. The tissue lining of the canal may be swollen; in severe cases, the swelling can extend into the soft tissue surrounding the ear. Tender erythematous swelling or an underlying furuncle may be present, and it may be pointing or draining.

The canal may be erythematous and dry, or it may be covered with fuzzy cottonlike grayish or black fungal plaques (wet newspaper appearance). Most often, the canal lining is moist and covered with purulent drainage and debris, and cerumen is characteristically absent. The canal may be so swollen that it is difficult or impossible to view the tympanic membrane (TM) ( Fig. 35.2 ), which, when visible, often looks dull.

A pruritic vesiculopapular eruption in the canal is most consistent with an allergic reaction to a topical agent (often neomycin) (see Chapter 162 ).