As you know Wax Removal is now one of the courses we run at TJ Audiology Training. This blog is about what Otitis Externa is; how to spot the signs and what to do, if you are removing wax, about to take an impression or to do a hearing test.
What is otitis externa? Firstly, it’s in the name Otitis is Latin for ear and Externa is external ear and it is an inflammation/infection of that area (generally it just the ear canal). Some people call it swimmers’ ear. But be aware this can mean something different depending on the region you live in the UK or what country you are in.
What causes Otitis Externa?
We aren’t exactly sure but some of the possible causes are:
- Damage to the skin in the ear canal (caused by cotton buds, scratching or poking) can cause inflammation and infection.
- Water can get into the ear canal during swimming. The stagnant water triggers an infection (Remember all water contains pseudomonas bacteria) . This often happens if there is a lot of wax and the water gets stuck behind the wax.
- Hot, humid weather makes inflammation of the ear canal more likely to develop.
- Skin conditions such as eczema, or psoriasis, can make someone more likely to get problems with the ear canal.
- Diabetes, radiotherapy (near the ear) and immune and conditions that effect the immune system can also make the client more prone to infection
How to spot the signs?
- In general the first sign your client will complain of is persistent itchiness and dry flaky skin around he canal and their may be some redness too.
- Smell – this like off cheese or smelly socks (it stays with you when you smell it!)
- A watery discharge from the ear canal (this can change later when its whiter)
- Discomfort moving the jaw when chewing or speaking.
- The ear canal starting to close up due to swelling and inflammation.
- Reduced hearing due to the canal being full of discharge or the canal is completely swollen
- Fungal spores are also a form of otitis externa. These will be either white and furry or black (see picture below)
What should you do as an ear care professional?
Firstly, if they are seeing you for ear impressions or a hearing test, then you need to send them away. The swollen canal will prevent an accurate impression and you can’t do a hearing test as the risk of cross infection is too high.
What if they are seeing you for wax removal?
It may be that you can’t see it or smell it till you have removed some wax. If this is the case then remove as much as you can comfortably for the client. This will give any intervention a better chance of working, as you have made the canal clear of as much debris and discharge for antibiotics to work on the skin. Remember the ear may be sore so you may have to work slowly and gently and you not be able to remove all of it. (Please note irrigation is not an option here only microsuction; as water from irrigation will make things worse).
Remind them of good aural hygiene. No water near the ears and no touching of the ears whatsoever.
Once you have removed the wax and discharge, refer the client to the GP. They may prescribe eardrops or spray. Often, it’s a combination of an antibiotic to treat any infection, and a steroid to reduce the inflammation and itching. The treatment usually lasts for 7 to 10 days. They need to follow the prescribed course. If they return to you because the treatment hasn’t worked, then you need to recommend that the nurse or GP take a swab sample, as the antibiotics may be the wrong type for the bacteria present.
Lastly
If the canal is swollen shut and the pinna and the concha are also swollen then the otitis externa has developed into cellulitis, this is a rare occurrence/side effect . (This may have occurred due to the client scratching the already infected ear and adding another bacteria). They will require intravenous antibiotics for this, so in this case suggest they attend A+E as this cannot be given at a GP surgery.
