External Ear Disease & Otitis Externa
Assess canal inflammation, select safe local treatment and recognise invasive infection.
Quick revision ↓ Medical Dictionary
01Local inflammation
Otitis externa often causes canal pain, itch and discharge, with tenderness on tragal pressure or pinna movement. Water exposure, instrumentation and skin disease can predispose. Inspect the canal and assess whether the drum can be seen. Hearing may fall when swelling or debris obstructs the canal, but sudden unexplained loss needs its own assessment.
02Treatment principles
Appropriate topical treatment and careful canal care are commonly used for uncomplicated disease. The choice depends on severity, likely cause, local guidance and tympanic membrane integrity. Cleaning or wick placement may need trained staff. Explain how to use treatment, avoid further instrumentation and keep the ear appropriately protected from water during recovery.
03Perforation changes choices
A known or possible perforation, grommet or previous ear operation affects the safety of drops and irrigation. Do not assume every product is suitable for an open middle ear. Seek an appropriate non-ototoxic preparation and specialist advice where indicated. Repeated blind cleaning attempts can injure the canal or drum and should be avoided.
04Necrotising infection
Severe persistent pain, especially at night, with discharge in a patient with diabetes or immunosuppression raises concern for necrotising otitis externa. Granulation tissue or cranial nerve deficits increases concern. This requires urgent specialist assessment for deeper infection, not simply another routine course of drops. The label describes invasive infection rather than a malignancy.
05Pinna and referred pain
Pinna swelling after cartilage piercing can represent perichondritis and warrants prompt assessment. A fluctuant swelling after trauma may be an auricular haematoma requiring timely care to prevent deformity. If the ear examination is normal, consider referred pain from dental, jaw, throat or other head-and-neck disease, particularly when symptoms persist.
High-Yield Revision
- Pain with tragal or pinna movement supports canal disease.
- Check perforation and surgery history before choosing drops.
- Persistent severe nocturnal pain in diabetes is a warning sign.
Common Pitfalls
- Repeated blind instrumentation of a swollen canal.
- Treating possible invasive infection as uncomplicated otitis externa.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.