Hearing aid use and swimming is forbidden until the infection has resolved. Suspicion of necrotizing external otitis should be raised in patients who fail to respond promptly to treatment for routine external otitis or have ear pain out of proportion to their clinical examination. A fungal infection, which may be the result of treatment with antibiotic ear drops, often causes itching and requires careful microscopic cleaning of the ear canal and treatment with antifungal drops or powder. It usually results from longstanding Eustachian tube dysfunction, but may also occur as a result of trauma to the middle ear. In some patients, the inflamed and swollen mucosa protrudes through the perforation into the ear canal as an aural polyp.
Patients usually report ear drainage and hearing loss.
Pain is relatively uncommon in chronic otitis media and, when present, suggests the possibility of trapped pus or erosion of bone. Cholesteatoma or chronic mastoiditis should always be considered if an ear with a tympanic membrane perforation shows a recurrent tendency to drain. It is critical that macerated and infected material be removed from the ear canal with the help of a microscope in order to maximize the effectiveness of treatment. Microscopic examination by an otologist can also help exclude conditions such as cholesteatoma. An oral antibiotic, or occasionally intravenous antibiotic for refractory cases, is often required.