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Otitis externa

The predominant symptom of acute otitis externa is tenderness of the pinna, which worsens when the outer ear is touched or gently pulled. Additionally, pushing the tragus (the tablike portion of the auricle in front of the ear canal) typically causes pain, aiding in diagnosis. Other symptoms include ear discharge and itchiness. When swelling and discharge block the ear canal, temporary conductive hearing loss may occur.

Causes
Otitis externa develops when germs infect the skin of the ear canal, often facilitated by impairments in skin integrity. Healthy skin usually resists infection unless exposed to a high concentration of pathogens. However, chronic skin conditions like atopic dermatitis, psoriasis, or trauma can predispose to infection. Fungal infections, or otomycosis, can vary in severity, often exacerbated by prolonged use of steroid-containing antibacterial ear drops.

Swimming and Other Factors
Swimming in polluted water or water trapped in the ear after a shower can lead to otitis externa, particularly in humid climates. Prolonged swimming can saturate the ear canal skin, making it susceptible to damage from cleaning attempts. Constriction of the ear canal from bone growth (Surfer’s ear) or occupational exposure in saturation divers can also lead to infection.

Objects in Ear
Using objects like cotton swabs to clear the ear canal can cause skin breaks, allowing infection to develop. Once inflamed, the condition can worsen from further scratching or water exposure.

Infections
Most cases are due to Pseudomonas aeruginosa and Staphylococcus aureus, with Candida albicans and Aspergillus species being common fungal pathogens.