Swimmer's Ear

Otitis Externa

Acute diffuse otitis externa (swimmer's ear) is an inflammatory infection of the external ear canal. Clinical presentation usually consists of pain, tenderness, itching and otorrhea. Epithelial breakdown from trauma and repeated exposure to moisture can predispose patients to this condition. 3 Complications of acute otitis externa include ear canal stenosis, tympanic membrane perforation, auricular cellulitis and progression to necrotizing otitis externa. 4 P. aeruginosa is the pathogen responsible in 40 to 60 percent of cases of otitis externa, and S. aureus causes 15 to 30 percent of cases. Fungi account for 10 percent of these infections in most settings, but the incidence increases in areas of high humidity. 3-5

A recent, large study 4 of acute otitis externa treatment patterns among subspecialists and generalists revealed that a combination topical product containing polymyxin B, neomycin (an aminoglycoside) and 1 percent hydrocortisone (Cortisporin) is the most frequently prescribed treatment for this condition. The results also showed that a significant number of physicians inappropriately prescribe oral antibiotics that are not active against P. aeruginosa and S. aureus, the two most common pathogens in acute otitis externa. Am Fam Physician. 2000 Oct 15;62(8):1870-6.