Pain is not usually a symptom in the earliest stage of otitis externa but starts soon after the itching and results from swelling of the ear canal skin. Hearing loss, if present, is due to narrowing of the ear canal by swelling and debris. Factors often associated with otitis externa are injury to the ear canal skin, such as Q-tip use, a scratch from a bobby pin or similar instrument, hearing aid use, and water exposure from bathing or swimming. Skin conditions such as seborrhea, eczema, or chemical sensitivities may increase the likelihood of otitis externa. The best treatment for otitis externa is its prevention.
Severe cases require specific treatment, usually antibiotic ear drops.
If ear canal swelling prevents the instillation of the antibiotic drops, insertion of a compressed sterile merocel sponge into the ear canal by an otolaryngologist or otologist may be required to help the drops penetrate the depths of the canal. 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.