eMedicine Specialties > Sports Medicine > Face and Head

Otitis Externa: Follow-up

Author: Joseph P Garry, MD, FACSM, FAAFP,, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise and Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
Coauthor(s): Sanjiv K Bhalla, MD, Consulting Staff, Department of Emergency Medicine, St Paul's Hospital of Vancouver, St Joseph's Hospital of Hamilton
Contributor Information and Disclosures

Updated: Nov 30, 2007

Follow-up

Further Outpatient Care

Follow-up is important in order to ascertain the patient's response to treatment for otitis externa. Even in mild cases, the patient should be reassessed 2-3 days following the initiation of treatment.

Deterrence/Prevention

  • Several measures that are related to ear hygiene may be taken to help prevent recurrent otitis externa infections.
    • Eliminate any self-inflicted trauma to the ear canal, such as using cotton swabs or inserting objects into the external auditory canal.
    • Avoid frequent washing of the ears with soap, as this leaves an alkali residue that neutralizes the acidic pH of the ear canal.
    • Avoid swimming in polluted waters.
    • Ensure that the ear canals are emptied of water after swimming or bathing.
  • Prophylactic ear drops: A combination of a 2:1 ratio of 70% isopropyl alcohol and acetic acid may be used after each episode of swimming to assist in drying and acidifying the ear canal.
  • Generally, earplugs should be avoided due to the fact that these objects may cause trauma to the ear canal, thereby predisposing to the development of otitis externa.

Complications

  • Complications of otitis externa include local purulent extension of disease, such as the following:
    • Necrotizing otitis externa
    • Mastoiditis
    • Chondritis of the auricle
    • Bony erosion of the base of the skull
    • Central nervous system (CNS) infection

Prognosis

  • The patient may return to aquatic activities once the infection has been eradicated, generally within 4-5 days.
  • Aquatic athletes may return to the pool earlier than 4-5 days; however, they need to keep their ear canals dry. Generally, after 2-3 days of refraining from any water activity, the athlete can return to water activities but the head should be kept dry until the infection has been eradicated.

Patient Education

  • Otitis externa is a common problem with risk factors that can be easily avoided. Prevention of this common medical condition for aquatic athletes is the most important advancement in the past decade. When otitis externa does strike, the condition can usually be resolved in a short time with few complications.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize and appropriately treat the complications of otitis externa is the most significant medical/legal pitfall.
 


More on Otitis Externa

Overview: Otitis Externa
Differential Diagnoses & Workup: Otitis Externa
Treatment & Medication: Otitis Externa
Follow-up: Otitis Externa
References
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References

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  3. Rosenfeld RM, Brown L, Cannon CR, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. Apr 2006;134(4 suppl):S4-23. [Medline].

  4. Osguthorpe JD, Nielsen DR. Otitis externa: review and clinical update. Am Fam Physician. Nov 1 2006;74(9):1510-6. [Medline]. [Full Text].

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  7. Rowlands S, Devalia H, Smith C, Hubbard R, Dean A. Otitis externa in UK general practice: a survey using the UK General Practice Research Database. Br J Gen Pract. Jul 2001;51(468):533-8. [Medline]. [Full Text].

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  9. Clark WB, Brook I, Bianki D, Thompson DH. Microbiology of otitis externa. Otolaryngol Head Neck Surg. Jan 1997;116(1):23-5. [Medline].

  10. Grandis JR, Curtin HD, Yu VL. Necrotizing (malignant) external otitis: prospective comparison of CT and MR imaging in diagnosis and follow-up. Radiology. Aug 1995;196(2):499-504. [Medline]. [Full Text].

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Further Reading

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Keywords

swimmer's ear, acute diffuse otitis externa, acute localized otitis externa, necrotizing otitis externa, eczematous otitis externa, infection of the external auditory canal

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Contributor Information and Disclosures

Author

Joseph P Garry, MD, FACSM, FAAFP,, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise and Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
Joseph P Garry, MD, FACSM, FAAFP, is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, and North American Primary Care Research Group
Disclosure: Nothing to disclose.

Coauthor(s)

Sanjiv K Bhalla, MD, Consulting Staff, Department of Emergency Medicine, St Paul's Hospital of Vancouver, St Joseph's Hospital of Hamilton
Sanjiv K Bhalla, MD is a member of the following medical societies: American College of Emergency Physicians, British Columbia Medical Association, Canadian Association of Emergency Physicians, Canadian Medical Association, Canadian Medical Protective Association, and Ontario Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Andrew L Sherman, MD, MS, Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, Leonard A Miller School of Medicine, University of Miami
Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, American Medical Association, American Paraplegia Society, American Spinal Injury Association, and Association of Academic Physiatrists
Disclosure: pfizer Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa
Disclosure: Nothing to disclose.

 
 
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