Chapter 23: Inflammatory and Infectious Disorders of the Ear

Otitis externa, commonly known as swimmer's ear, involves inflammation of the auditory canal and surrounding outer ear structures and is typically caused by bacterial infection, most frequently from Pseudomonas aeruginosa or Staphylococcus aureus in acute presentations. Risk factors include prolonged moisture exposure, inadequate cerumen protection, trauma from foreign objects, and certain skin conditions. The condition presents with severe otalgia that worsens with manipulation of the pinna or tragus, along with pruritus, hearing loss, and purulent discharge that varies in appearance depending on causative organism. Chronic otitis externa may result from fungal infections, while necrotizing otitis externa represents a medical emergency requiring aggressive intervention, particularly in elderly, diabetic, or immunocompromised patients. Treatment depends on severity and involves topical antibiotics for uncomplicated cases, with careful attention to avoiding ototoxic agents if tympanic membrane perforation exists. Otitis media, affecting the middle ear, occurs through eustachian tube dysfunction typically triggered by viral upper respiratory infection, leading to negative pressure and fluid accumulation. This condition presents differently across variants: acute otitis media features fever, deep ear pain, and potentially ruptured tympanum; otitis media with effusion presents as painless conductive hearing loss with aural fullness; and chronic otitis media involves persistent otorrhea without pain. The chapter emphasizes age-specific management approaches, including watchful waiting strategies in select pediatric populations before antibiotic initiation, with amoxicillin as first-line therapy for bacterial infection. Prevention strategies focus on minimizing risk factors through breastfeeding, vaccination, and environmental modifications, while diagnostic confirmation relies primarily on pneumatic otoscopy and clinical assessment rather than routine cultures.