The ear canal cleanses itself by moving desquamated epithelium, as on a conveyor belt, from the tympanic membrane outward. The patient's attempts to clean the canal with cotton applicators interrupt the self-cleansing mechanism and promote accumulation of debris by pushing it in the direction opposite the movement of the desquamated epithelium. Symptoms and Signs Patients with diffuse external otitis complain of itching, pain, a foul-smelling discharge, and hearing loss if the canal becomes swollen or filled with purulent debris. Tenderness on traction of the pinna and on pressure over the tragus tends to distinguish external otitis from otitis media. The skin of the ear canal is red, swollen, and littered with moist, purulent debris.
Furuncles cause severe pain and, when draining, brief sanguineous purulent otorrhea.
The alcohol helps remove water, and the vinegar alters the pH of the canal. Systemic antibiotics are seldom necessary unless there is a spreading cellulitis or other evidence of infection spreading outside the canal skin. In diffuse external otitis, topical antibiotics and corticosteroids are effective. First, the infected debris is gently and thoroughly removed from the canal with suction or dry cotton wipes. An analgesic, such as codeine 30 mg po q 4 h, is usually necessary for the first 24 to 48 h.