External Otitis with a twist

Some of the patients you serve may have recurrent otitis externa for which no medication seems to help.  In this situation, the real culprit may be eczema in the external ear canal.  The medical term is chronic eczematous external otitis.  Sometimes the only symptom will be itching or pain in the ear canal, with no flaking or visible inflammation. It is often recurring and may be linked to allergies.

Otitis externa is typically described as inflammation or infection in the external canal. It can be caused by bacterial or fungal infections, which need to be treated differently by a physician.    This information is good to know for those individuals we see that just can not leave the idea of cerumen alone, because the lack of earwax can leave us more susceptible to otitis externa.  Ear wax (cerumen)  has  sanitary benefits which can be overlooked because it is such a noxious substance.

What do you do if the treatments for bacterial or fungal infections are not working? Consider skin conditions and refer to a physician as needed to rule out or treat for eczema or psoriasis:

Skin conditions as causes of otitis externa are often suspected due to clues in the patient’s history. Common skin conditions that may result in otitis externa include eczema (e.g. atopic eczema or contact dermatitis) and psoriasis. Think about contact dermatitis in patients using earplugs, hearing aids, earrings or sensitizing medications—whether topical or systemic. (bold added)

Like a lot of us in our profession, an Audiologist friend of mine has a long history of putting things in her ears:  inserting patients’ hearing aids into her ears during listening checks and also faithfully using ear plugs in noise.  Although she was careful to wipe down the hearing aids and wash her hands, she was less careful about re-using her own ear plugs.  She did that one time to often, apparently, and ended up with recurrent right ear pain without visible inflammation or discharge.  Two physicians diagnosed generalized external otitis media for want of any other available diagnosis, and prescribed drops.  But, after multiple antibiotics and steroids failed to work, my friend did research herself to find a solution.  One substance which can help aural eczma specifically–and which finally resolved my friend’s problem– is DermOtic Oil or fluocinolone acetonide oil.  It is a topical corticosteroid, anti-inflammatory, antipruritic and vasoconstrictive.   There is refined peanut oil in the ingredients and should be pointed out to those who are peanut sensitive.

It seems we see patients who talk about itchy ears quite often–sometimes to the point that they remove their hearing aids due to what they call “irritation.”  If there is an absence of wax, possible redness and possible flaking (but do not count on this), itching or pain, then a referral to a physician for possible treatment with flucinolone acetonide oil or other medications may be in order.  Here’s a link to a full medical description of external otitis media, for hand-outs to patients or for consumers reading this blog.

If anyone has an out-of-the-ordinary diagnosis, syndrome, or set of unexplained complaints that you would like to have researched and written on, let us know!

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