414:, in which there are no symptoms and the fungus simply co-exists in the ear canal in a commensal relationship with the host, in which case the only physical finding is the presence of a fungus. If the fungus begins active reproduction, the ear canal can fill with dense fungal debris, causing pressure and ever-increasing pain that is unrelenting until the fungus is removed from the canal and anti-fungal medication is used. Most antibacterial ear drops also contain a steroid to hasten resolution of canal edema and pain. Unfortunately, such drops make the fungal infection worse. Prolonged use of them promotes the growth of fungus in the ear canal. Antibacterial ear drops should be used for a maximum of one week, but 5 days is usually enough. Otomycosis responds more than 95% of the time to a three-day course of the same over-the-counter anti-fungal solutions used for athlete's foot.
667:
canal to be effective. The physician may need to carefully insert a wick of cotton or other commercially available, pre-fashioned, absorbent material called an ear wick and then saturate that with the medication. The wick is kept saturated with medication until the canal opens enough that the drops will penetrate the canal without it. Removal of the wick does not require a health professional. Antibiotic ear drops should be dosed in a quantity that allows coating of most of the ear canal and used for no more than 4 to 7 days. The ear should be left open. It is imperative that visualization of an intact
724:
Beginning as infection of the external ear canal, there is an extension of the infection into the bony ear canal and the soft tissues deep to the bony canal. Unrecognized and untreated, it may result in death. The hallmark of malignant otitis externa (MOE) is unrelenting pain that interferes with sleep and persists even after swelling of the external ear canal may have resolved with topical antibiotic treatment. It can also cause skull base osteomyelitis (SBO), manifested by multiple cranial nerve palsies, described below under the "Treatment" heading.
60:
548:
from injury caused by attempts at self-cleaning or scratching with cotton swabs, pen caps, fingernails, hair pins, keys, or other small implements. Another causative factor for acute infection is prolonged water exposure in the forms of swimming or exposure to extreme humidity, which can compromise the protective barrier function of the canal skin, allowing bacteria to flourish, hence the name "swimmer's ear".
1940:
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susceptible to further damage if the ear is instrumented with cotton swabs after swimming. Main symptoms of swimmer’s ear are a feeling of fullness in the ear, itchiness, redness, and swelling in or around the ear canal, muffled hearing, pain in the external ear and ear canal and especially a smelly discharge from the ear.
750:
can spread deeper into the head and involve the bones of the skull base, constituting skull base osteomyelitis (SBO). Multiple cranial nerve palsies can result, including the facial nerve (causing facial palsy), the recurrent laryngeal nerve (causing vocal cord paralysis), and the cochlear nerve (causing deafness).
629:
Ear drops are the mainstay of treatment for external otitis. Some contain antibiotics, either antibacterial or antifungal, and others are simply designed to mildly acidify the ear canal environment to discourage bacterial growth. Some prescription drops also contain anti-inflammatory steroids, which
585:
when swimming and shampooing hair may help prevent external otitis, there are important details in the use of plugs. Hard and poorly fitting earplugs can scratch the ear canal skin and set off an episode. When earplugs are used during an acute episode, either disposable plugs are recommended, or used
425:
in polluted water is a common way to contract swimmer's ear, but it is also possible to contract swimmer's ear from water trapped in the ear canal after a shower, especially in a humid climate. Prolonged swimming can saturate the skin of the canal, compromising its barrier function and making it more
356:
Tenderness of pinna is the predominant complaint and the only symptom directly related to the severity of acute external otitis. Unlike other forms of ear infections, we observe tenderness in outer ear i.e., the pain of acute external otitis is worsened when the outer ear is touched or pulled gently.
547:
The skin of the bony ear canal is unique, in that it is not movable but is closely attached to the bone, and it is almost paper-thin. For these reasons, it is easily abraded or torn by even minimal physical force. Inflammation of the ear canal skin typically begins with a physical insult, most often
449:
or other small objects to clear the ear canal is enough to cause breaks in the skin, and allow the condition to develop. Once the skin of the ear canal is inflamed, external otitis can be drastically enhanced by either scratching the ear canal with an object or by allowing water to remain in the ear
812:
in 1969 there was a great deal of otitis externa. The Diving
Medical Officer devised a prophylaxis that came to be known as, "Tektite Solution", equal parts of 15% tannic acid, 15% acetic acid and 50% isopropyl alcohol or ethanol. During Tektite ethanol was used because it was available in the lab
323:
Otitis externa affects 1–3% of people a year; more than 95% of cases are acute. About 10% of people are affected at some point in their lives. It occurs most commonly among children between the ages of seven and twelve and among the elderly. It occurs with near equal frequency in males and females.
749:
Unlike ordinary otitis externa, MOE requires oral or intravenous antibiotics for cure. Pseudomonas is the most common offending pathogen. Diabetes control is also an essential part of treatment. When MOE goes unrecognized and untreated, the infection continues to smolder and over weeks or months
666:
Removal of debris (wax, shed skin, and pus) from the ear canal promotes direct contact of the prescribed medication with the infected skin and shortens recovery time. When canal swelling has progressed to the point where the ear canal is blocked, ear drops may not penetrate far enough into the ear
365:
that projects out just in front of the ear canal opening, also typically causes pain in this condition as to be diagnostic of external otitis on physical examination. People may also experience ear discharge and itchiness. When enough swelling and discharge in the ear canal is present to block the
723:
Necrotizing external otitis (malignant otitis externa) is an uncommon form of external otitis that occurs mainly in elderly diabetics, being somewhat more likely and more severe when the diabetes is poorly controlled. Even less commonly, it can develop due to a severely compromised immune system.
786:
are paralyzed, shortness of breath may develop and necessitate tracheotomy. Profound deafness can occur, usually later in the disease course due to relative resistance of the inner ear structures. Gallium scans are sometimes used to document the extent of the infection but are not essential to
736:
course than ordinary acute otitis externa. There may be granulation involving the floor of the external ear canal, most often at the bony-cartilaginous junction. Paradoxically, the physical findings of MOE, at least in its early stages, are often much less dramatic than those of ordinary acute
641:
Although the acute external otitis generally resolves in a few days with topical washes and antibiotics, complete return of hearing and cerumen gland function may take a few more days. Once healed completely, the ear canal is again self-cleaning. Until it recovers fully, it may be more prone to
502:
at the initial examination because of narrowing of the ear canal from inflammation and the presence of drainage and debris. Sometimes the diagnosis of external otitis is presumptive and return visits are required to fully examine the ear. The culture of the drainage may identify the bacteria or
753:
The infecting organism is almost always pseudomonas aeruginosa, but it can instead be fungal (aspergillus or mucor). MOE and SBO are not amenable to surgery, but exploratory surgery may facilitate the culture of unusual organism(s) that are not responding to empirically used anti-pseudomonal
657:
to reduce itching and inflammation. In painful cases, a topical solution of antibiotics such as aminoglycoside, polymyxin or fluoroquinolone is usually prescribed. Antifungal solutions are used in the case of fungal infections. External otitis is almost always predominantly bacterial or
594:
during otherwise "dry" exercise in the summer has been associated with the development of swimmer's ear since the plugs can create a warm and moist environment inside the ears. The source claims that on-ear or over-ear headphones can be a better alternative for preventing swimmer's ear.
567:
After prolonged swimming, a person prone to external otitis can dry the ears using a small battery-powered ear dryer, available at many retailers, especially shops catering to watersports enthusiasts. Alternatively, drops containing dilute acetic acid (vinegar diluted 3:1) or
630:
help to resolve swelling and itching. Although there is evidence that steroids are effective at reducing the length of treatment time required, fungal otitis externa (also called otomycosis) may be caused or aggravated by overly prolonged use of steroid-containing drops.
523:
In contrast to the chronic otitis externa, acute otitis externa (AOE) is predominantly a bacterial infection, occurs suddenly, rapidly worsens, and becomes painful. The ear canal has an abundant nerve supply, so the pain is often severe enough to interfere with sleep.
369:
Because the symptoms of external otitis lead many people to attempt to clean out the ear canal (or scratch it) with slim implements, self-cleaning attempts generally lead to additional traumas of the injured skin, so rapid worsening of the condition often occurs.
382:
that can infect the skin and (2) impairments in the integrity of the skin of the ear canal that allow an infection to occur. If the skin is healthy and uninjured, only exposure to a high concentration of pathogens, such as submersion in a pond contaminated by
1995:
1980:
799:
The incidence of otitis externa is high. In the
Netherlands, it has been estimated at 12–14 per 1000 population per year, and has been shown to affect more than 1% of a sample of the population in the United Kingdom over a 12-month period.
633:
Antibiotics by mouth should not be used to treat uncomplicated acute otitis externa. Antibiotics by mouth are not a sufficient response to bacteria which cause this condition and have significant side effects including increased risk of
758:
being the drug of choice). The usual surgical finding is diffuse cellulitis without localized abscess formation. SBO can extend into the petrous apex of the temporal bone or more inferiorly into the opposite side of the skull base.
1634:
Kashiwamura M. Chida E. Matsumura M. Nakamaru Y. Suda N. Terayama Y. Fukuda S. The efficacy of Burow's solution as an ear preparation for the treatment of chronic ear infections. Otology & Neurotology. 25(1):9–13,
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to the base of the skull are more likely to develop complications, including malignant otitis externa. In these individuals, rapid examination by an otolaryngologist (ear, nose, and throat physician) is very important.
510:
The diagnosis may be missed in most early cases because the examination of the ear, with the exception of pain with manipulation, is nearly normal. In some early cases, the most striking visual finding is the lack of
564:
into the ear canal: use of cotton buds or swabs is the most common event leading to acute otitis externa. Most normal ear canals have a self-cleaning and self-drying mechanism, the latter by simple evaporation.
494:-like, with scaly shedding of skin. Touching or moving the outer ear increases the pain, and this maneuver on physical exam is important in establishing the clinical diagnosis. It may be difficult to see the
1806:
Lesser FD, Derbyshire SG, Lewis-Jones H (28 August 2015). "Can computed tomography and magnetic resonance imaging differentiate between malignant pathology and osteomyelitis in the central skull base?".
638:. In contrast, topical products can treat this condition. Oral anti-pseudomonal antibiotics can be used in case of severe soft tissue swelling extending into the face and neck and may hasten recovery.
608:
Effective solutions for the ear canal include acidifying and drying agents, used either singly or in combination. When the ear canal skin is inflamed from the acute otitis externa, the use of dilute
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1668:
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production, or if there has been a break in the skin from trauma, even the normal bacteria found in the ear canal may cause infection and full-blown symptoms of external otitis.
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may be used. It is especially important not to instrument ears when the skin is saturated with water, as it is very susceptible to injury, which can lead to external otitis.
1591:
2303:
1514:
Rosenfeld RM, Schwartz, S. R., Cannon, C. R., Roland, P. S., Simon, G. R., Kumar, K. A., Huang, W. W., Haskell, H. W., Robertson, P. J. (3 February 2014).
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otitis externa. In later stages, there can be soft tissue swelling around the ear, even in the absence of significant canal swelling. While fever and
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fungus causing infection, but is not part of the routine diagnostic evaluation. In severe cases of external otitis, there may be swelling of the
528:
in the ear can combine with the swelling of the canal skin and the associated pus to block the canal and dampen hearing, creating a temporary
2100:
1012:
853:
741:
might be expected in response to bacterial infection invading the skull region, MOE does not cause fever or elevation of white blood count.
1614:
515:. As a moderate or severe case of external otitis resolves, weeks may be required before the ear canal again shows a normal amount of it.
262:. The most common cause of otitis externa is bacterial. Risk factors for acute cases include swimming, minor trauma from cleaning, using
250:
Otitis externa may be acute (lasting less than six weeks) or chronic (lasting more than three months). Acute cases are typically due to
1894:
320:
around the ear. Typically, improvement occurs within a day of the start of treatment. Treatment of chronic cases depends on the cause.
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is a chronic disease that can require months of IV antibiotic treatment, tends to recur, and has a significant mortality rate.
1070:
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Otitis externa responds well to treatment, but complications may occur if it is not treated. Individuals with underlying
532:. In more severe or untreated cases, the infection can spread to the soft tissues of the face that surround the adjacent
387:, is likely to set off an episode. However, if there are chronic skin conditions that affect the ear canal skin, such as
1298:
2179:
1688:
Rosenfeld RM, Brown L, Cannon CR, Dolor RJ, Ganiats TG, Hannley M, Kokemueller P, Marcy SM, Roland PS (2006-04-01).
1380:
Rosenfeld RM, Brown L, Cannon CR, Dolor RJ, Ganiats TG, Hannley M, Kokemueller P, Marcy SM, Roland PS (2006-04-01).
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As the skull base is progressively involved, the adjacent exiting cranial nerves and their branches, especially the
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When the ear is inspected, the canal appears red and swollen in well-developed cases. The ear canal may also appear
1852:"Clinical efficacy of three common treatments in acute otitis externa in primary care: randomised controlled trial"
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1912:
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783:
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1250:"Identification of infectious Pseudomonas aeruginosa strains in an occupational saturation diving environment"
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plugs must be cleaned and dried properly to avoid contaminating the healing ear canal with infected discharge.
59:
2201:
635:
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is a very effective remedy against both bacterial and fungal external otitis. This is a buffered mixture of
537:
529:
283:
1337:
Zichichi L, Asta G, Noto G (April 2000). "Pseudomonas aeruginosa folliculitis after shower/bath exposure".
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A severe case of acute otitis externa. Note the narrowing of the ear channel, the large amounts of
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A moderate case of otitis externa. There is narrowing of the ear channel, with a small amount of
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782:, may be affected, resulting in facial paralysis and hoarseness, respectively. If both of the
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Lee H, Kim J, Nguyen V (September 2013). "Ear infections: otitis externa and otitis media".
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671:(eardrum) is noted. Use of certain medications with a ruptured tympanic membrane can cause
2293:
1898:
1663:
1659:
1568:"Wearing earbuds in the summer could cause a nasty ear infection — here's how to avoid it"
1221:
Cobet AB, Wright DN, Warren PI (June 1970). "Tektite-I program: bacteriological aspects".
809:
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have suggested that most people will have at least a brief episode at some point in life.
349:
292:
ear drops may be used as a preventive measure. Treatment of acute cases is typically with
72:
1093:
Kang K, Stevens SR. Pathophysiology of atopic dermatitis. Clin
Dermatol 2003; 21:116–121.
430:
378:
The two factors that are required for external otitis to develop are (1) the presence of
312:
may be used for the pain. Antibiotics by mouth are not recommended unless the person has
33:
1928:
1200:"Surfer Ears – University of California Irvine Otolaryngology –?Head & Neck Surgery"
556:
The strategies for preventing acute external otitis are similar to those for treatment.
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2012:
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2004:
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540:, making chewing painful. In its mildest forms, otitis externa is so common that some
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predominantly fungal so that only one type of medication is necessary and indicated.
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Avoid washing hair or swimming if very mild symptoms of acute external otitis begin.
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1936:
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358:
240:
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101:
1299:"A Prophylactic Program for the Prevention of Otitis Externa in Saturation Divers"
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470:, followed by a great number of other gram-positive and gram-negative species.
17:
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1820:
1607:"Swimmers Ear – Additional Advice About A Pesky and Sometimes Painful Problem"
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1989:
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species are the most common fungal pathogens responsible for the condition.
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Schaefer P, Baugh RF (1 December 2012). "Acute otitis externa: an update".
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1972:
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opening, external otitis may cause temporary conductive hearing loss.
1984:
1756:"Malignant otitis externa: experience with hyperbaric oxygen therapy"
1516:"Clinical Practice Guideline: Acute Otitis Externa Executive Summary"
525:
512:
491:
384:
1913:""Tektite": A Blueprint for Cooperative Undersea Scientific Program"
1754:
Saxby A, Barakate M, Kertesz T, James J, Bennett M (December 2010).
339:
331:
844:
Rapini, Ronald P., Bolognia, Jean L., Jorizzo, Joseph L. (2007).
324:
Those who live in warm and wet climates are more often affected.
247:. A high fever is typically not present except in severe cases.
2096:
1071:"What are the symptoms of ear infection - inner, middle, outer"
410:, range from inconsequential to extremely severe. Fungi can be
626:, and is available without prescription in the United States.
1303:
United States Navy
Experimental Diving Unit Technical Report
766:
as an adjunct to antibiotic therapy remains controversial.
642:
repeat infection from further physical or chemical insult.
445:
Even without exposure to water, the use of objects such as
437:
have reported otitis externa during occupational exposure.
1305:. NEDU-RR-10-74. Archived from the original on 2008-08-20
1669:
American
Academy of Otolaryngology–Head and Neck Surgery
1651:
American
Academy of Otolaryngology–Head and Neck Surgery
286:
the ear canal may be useful in chronic or severe cases.
1655:"Five Things Physicians and Patients Should Question"
1004:
Harwood-Nuss' Clinical
Practice of Emergency Medicine
1962:
1007:. Lippincott Williams & Wilkins. p. PT428.
2253:
2232:
2160:
2137:
2052:
1966:
1850:van Balen F, Smit W, Zuithoff N, Verheij T (2003).
1690:"Clinical practice guideline: acute otitis externa"
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1382:"Clinical practice guideline: acute otitis externa"
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134:
116:
108:
91:
79:
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44:
1484:
1482:
1103:Wang MC, Liu CY, Shiao AS, Wang T (August 2005).
1001:Wolfson AB, Hendey GW, Ling LJ, Rosen CL (2009).
691:, disorders of the immune system, or history of
429:Constriction of the ear canal from bone growth (
282:. Diagnosis is based on the signs and symptoms.
266:and ear plugs, and other skin problems, such as
1749:
1747:
1745:
1743:
243:. Typically there is pain with movement of the
703:Spread of infection to other areas of the body
304:drops may be used in addition to antibiotics.
239:, swelling of the ear canal, and occasionally
2108:
1774:. Archived from the original on June 16, 2013
8:
1590:: CS1 maint: multiple names: authors list (
1248:Ahlén C, Mandal LH, Iversen OJ (July 1998).
916:Wipperman J (March 2014). "Otitis externa".
679:, dizziness and hearing loss in some cases.
140:Swimming, minor trauma from cleaning, using
1611:Diver's Alert Network: Alert Diver Magazine
1566:Avella Delano Samuels, Jessica Orwig, Joe.
590:According to one source, the use of in-ear
406:Fungal ear canal infections, also known as
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1809:The Journal of Laryngology & Otology
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450:canal for any prolonged length of time.
433:) can trap debris leading to infection.
833:
2304:Bacterium-related cutaneous conditions
1784:
1675:from the original on September 1, 2013
1583:
1439:"Microbiology of acute otitis externa"
1315:
254:, and chronic cases are often due to
7:
1694:Otolaryngology–Head and Neck Surgery
1520:Otolaryngology–Head and Neck Surgery
1494:The Lecturio Medical Concept Library
1386:Otolaryngology–Head and Neck Surgery
1064:
1062:
732:MOE follows a much more chronic and
25:
575:Avoid swimming in polluted water.
458:The majority of cases are due to
1917:Journal of the Atomic Scientists
1911:Ray E, Cohen R (February 1970).
1605:Doc Vikingo (March–April 2007).
1456:10.1097/00005537-200207000-00005
1351:10.1046/j.1365-4362.2000.00931.x
278:are at risk of a severe form of
1943:from the original on 2017-02-15
1617:from the original on 2008-06-12
1158:JAMA Otolaryngol Head Neck Surg
1152:Pierre JJ, Tolisano AM (2023).
787:disease management. Skull base
1937:10.1080/00963402.1970.11457770
1760:Diving and Hyperbaric Medicine
645:Effective medications include
542:ear nose and throat physicians
507:(s) directly beneath the ear.
336:A mild case of otitis externa.
53:External otitis, swimmer's ear
1:
1122:10.1016/S1726-4901(09)70174-1
361:, the tablike portion of the
100:, swelling of the ear canal,
27:Inflammation of the ear canal
1707:10.1016/j.otohns.2006.02.014
1437:Roland P, Stroman D (2002).
1399:10.1016/j.otohns.2006.02.014
2180:Eustachian tube dysfunction
1069:Meghanadh DK (2022-01-26).
709:Otitis externa haemorhagica
706:Necrotizing external otitis
2335:
1105:"Ear problems in swimmers"
820:
784:recurrent laryngeal nerves
31:
1868:10.1136/bmj.327.7425.1201
1821:10.1017/S0022215115001991
1791:: CS1 maint: unfit URL (
1322:: CS1 maint: unfit URL (
1170:10.1001/jamaoto.2023.0997
1045:10.1016/j.pop.2013.05.005
975:American Family Physician
930:10.1016/j.pop.2013.10.001
846:Dermatology: 2-Volume Set
823:Otitis externa in animals
764:hyperbaric oxygen therapy
235:. It often presents with
66:
57:
2309:Diseases of external ear
2185:Patulous Eustachian tube
1533:10.1177/0194599813517659
1154:"What Is Swimmer's Ear?"
813:for pickling specimens.
653:to fight infection, and
280:malignant otitis externa
32:Not to be confused with
1662:: an initiative of the
636:opportunistic infection
530:conductive hearing loss
700:Chronic otitis externa
461:Pseudomonas aeruginosa
353:
348:, and swelling of the
337:
174:Differential diagnosis
2209:Middle ear barotrauma
1449:(7 Pt 1): 1166–1177.
1297:Thalmann, ED (1974).
467:Staphylococcus aureus
393:seborrheic dermatitis
343:
335:
318:infection of the skin
2202:Gradenigo's syndrome
1266:10.1136/oem.55.7.480
848:. St. Louis: Mosby.
581:Although the use of
399:or abnormalities of
314:poor immune function
260:autoimmune disorders
214:~2% of people a year
129:autoimmune disorders
104:, difficulty chewing
71:and swelling of the
1929:1970BuAtS..26b..35R
252:bacterial infection
165:Based on symptoms,
121:Bacterial infection
86:Otorhinolaryngology
2219:Perforated eardrum
2053:External resources
1897:2006-03-10 at the
1700:(4 Suppl): S4-23.
1392:(4 Suppl): S4–23.
354:
338:
328:Signs and symptoms
2281:
2280:
2090:
2089:
1653:(February 2013),
1254:Occup Environ Med
1210:on July 17, 2009.
1014:978-0-7817-8943-1
855:978-1-4160-2999-1
693:radiation therapy
669:tympanic membrane
620:aluminium sulfate
435:Saturation divers
389:atopic dermatitis
241:decreased hearing
218:
217:
167:microbial culture
161:Diagnostic method
102:decreased hearing
39:Medical condition
16:(Redirected from
2326:
2314:Swimming culture
2224:Tympanosclerosis
2197:Bezold's abscess
2117:
2110:
2103:
2094:
1964:
1952:
1951:
1949:
1948:
1908:
1902:
1889:
1879:
1862:(7425): 1201–5.
1847:
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1572:Business Insider
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1490:"Otitis Externa"
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1377:
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1339:Int. J. Dermatol
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1310:
1294:
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1212:
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1206:. Archived from
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1109:J Chin Med Assoc
1100:
1094:
1091:
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969:
942:
941:
913:
860:
859:
841:
745:Treatment of MOE
718:
717:
616:Burow's solution
612:may be painful.
570:Burow's solution
560:Avoid inserting
473:Candida albicans
306:Pain medications
300:or acetic acid.
62:
42:
21:
2334:
2333:
2329:
2328:
2327:
2325:
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2323:
2319:Sports injuries
2284:
2283:
2282:
2277:
2249:
2228:
2164:
2156:
2133:
2124:Diseases of the
2121:
2091:
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1975:
1961:
1956:
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1910:
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1899:Wayback Machine
1849:
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1664:ABIM Foundation
1660:Choosing Wisely
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835:
830:
825:
819:
810:Tektite Project
806:
797:
772:
747:
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728:Natural history
721:
719:external otitis
715:
714:
685:
664:
655:corticosteroids
606:
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554:
521:
488:
456:
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296:drops, such as
40:
37:
28:
23:
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18:External otitis
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2147:Otitis externa
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1967:Classification
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1959:External links
1957:
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1815:(9): 852–859.
1798:
1766:(4): 195–200.
1739:
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1684:, which cites
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1526:(2): 161–168.
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519:Classification
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455:
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441:Objects in ear
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329:
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274:. People with
223:, also called
221:Otitis externa
216:
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202:drops such as
197:
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186:
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179:Perichondritis
176:
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144:or ear plugs,
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112:Acute, chronic
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45:Otitis externa
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2175:Cholesteatoma
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817:Other animals
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794:
792:
790:
789:osteomyelitis
785:
781:
777:
770:Complications
769:
767:
765:
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757:
756:ciprofloxacin
754:antibiotics (
751:
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534:parotid gland
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225:swimmer's ear
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206:, acetic acid
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35:
30:
19:
2271:tympanometry
2245:Hearing loss
2214:Otitis media
2146:
2071:
2060:
2036:
2025:
1994:
1979:
1945:. Retrieved
1923:(2): 35–40.
1920:
1916:
1906:
1890:
1859:
1855:
1845:
1812:
1808:
1801:
1787:cite journal
1776:. Retrieved
1763:
1759:
1697:
1693:
1677:, retrieved
1658:
1630:
1619:. Retrieved
1610:
1600:
1575:. Retrieved
1571:
1523:
1519:
1509:
1497:. Retrieved
1493:
1446:
1443:Laryngoscope
1442:
1432:
1389:
1385:
1375:
1342:
1338:
1332:
1318:cite journal
1307:. Retrieved
1302:
1292:
1257:
1253:
1243:
1226:
1222:
1216:
1208:the original
1203:
1194:
1161:
1157:
1147:
1112:
1108:
1098:
1089:
1078:. Retrieved
1074:
1036:
1033:Primary Care
1032:
1003:
996:
979:
973:
921:
918:Primary Care
917:
845:
807:
798:
795:Epidemiology
776:facial nerve
773:
761:
752:
748:
739:leukocytosis
731:
722:
686:
665:
644:
640:
632:
628:
614:
607:
589:
561:
555:
546:
522:
509:
489:
477:
471:
465:
459:
457:
447:cotton swabs
444:
431:Surfer's ear
428:
421:
405:
377:
368:
357:Pushing the
355:
322:
316:or there is
288:
279:
264:hearing aids
249:
229:inflammation
224:
220:
219:
142:hearing aids
136:Risk factors
34:Surfer's ear
29:
2192:Mastoiditis
2062:MedlinePlus
808:During the
780:vagus nerve
762:The use of
716:Necrotizing
651:antibiotics
649:containing
624:acetic acid
610:acetic acid
604:Medications
479:Aspergillus
412:saprophytic
290:Acetic acid
189:Acetic acid
50:Other names
2299:Pediatrics
2288:Categories
2162:Middle ear
2152:Otomycosis
2131:middle ear
2038:DiseasesDB
1947:2012-11-03
1778:2013-05-18
1621:2008-07-22
1577:2023-11-07
1309:2008-07-22
1223:Aerosp Med
1164:(7): 652.
1080:2022-05-30
924:(1): 1–9.
828:References
821:See also:
592:headphones
552:Prevention
505:lymph node
454:Infections
408:otomycosis
294:antibiotic
272:dermatitis
200:Antibiotic
185:Prevention
154:dermatitis
2266:pneumatic
2139:Outer ear
2081:emerg/350
2073:eMedicine
1892:Full text
1716:0194-5998
1679:August 1,
1499:25 August
1408:0194-5998
1186:259000499
1075:Medy Blog
683:Prognosis
647:ear drops
599:Treatment
538:jaw joint
486:Diagnosis
397:psoriasis
350:outer ear
310:ibuprofen
298:ofloxacin
284:Culturing
268:psoriasis
256:allergies
245:outer ear
233:ear canal
211:Frequency
204:ofloxacin
196:Treatment
191:ear drops
150:psoriasis
125:allergies
81:Specialty
73:outer ear
2261:Otoscope
2240:Ear pain
2233:Symptoms
2078:ped/1688
1941:Archived
1895:Archived
1886:14630756
1829:26314320
1772:23111934
1732:20340836
1724:16638473
1673:archived
1615:Archived
1586:cite web
1550:26425210
1542:24492208
1473:24612139
1465:12169893
1424:20340836
1416:16638473
1367:39610780
1359:10809975
1178:37261805
1139:20037932
1131:16138712
1053:23958363
988:23198673
938:24439876
778:and the
734:indolent
689:diabetes
673:tinnitus
662:Cleaning
583:earplugs
562:anything
536:and the
500:otoscope
498:with an
423:Swimming
418:Swimming
308:such as
276:diabetes
237:ear pain
146:diabetes
98:Ear pain
93:Symptoms
2167:mastoid
2032:D010032
1925:Bibcode
1837:7874505
1284:9816382
1275:1757612
1235:4392833
804:History
677:vertigo
496:eardrum
401:keratin
363:auricle
346:exudate
302:Steroid
231:of the
69:exudate
2294:Otitis
2067:000622
2013:112.82
2009:054.73
2005:053.71
1884:
1877:274056
1874:
1835:
1827:
1770:
1730:
1722:
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1548:
1540:
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1176:
1137:
1129:
1051:
1011:
986:
936:
852:
513:earwax
492:eczema
385:sewage
374:Causes
359:tragus
117:Causes
2254:Tests
2127:outer
2021:380.2
2017:380.1
1833:S2CID
1728:S2CID
1546:S2CID
1469:S2CID
1420:S2CID
1363:S2CID
1182:S2CID
1135:S2CID
380:germs
227:, is
109:Types
2165:and
2129:and
2043:9401
2027:MeSH
2000:9-CM
1921:XXIV
1882:PMID
1825:PMID
1793:link
1768:PMID
1720:PMID
1712:ISSN
1681:2013
1635:2004
1592:link
1538:PMID
1501:2021
1461:PMID
1412:PMID
1404:ISSN
1355:PMID
1324:link
1280:PMID
1231:PMID
1174:PMID
1127:PMID
1049:PMID
1009:ISBN
984:PMID
934:PMID
850:ISBN
622:and
476:and
464:and
270:and
258:and
1996:ICD
1990:H60
1981:ICD
1933:doi
1872:PMC
1864:doi
1860:327
1856:BMJ
1817:doi
1813:129
1702:doi
1698:134
1528:doi
1524:150
1451:doi
1447:112
1394:doi
1390:134
1347:doi
1270:PMC
1262:doi
1166:doi
1162:149
1117:doi
1041:doi
926:doi
526:Wax
2290::
2076::
2065::
2041::
2030::
2015:,
2011:,
2007:,
2003::
1988::
1985:10
1939:.
1931:.
1919:.
1915:.
1880:.
1870:.
1858:.
1854:.
1831:.
1823:.
1811:.
1789:}}
1785:{{
1764:40
1762:.
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1742:^
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1667:,
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1481:^
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