Literature Review: Pathophysiology, Diagnosis, Management, and Prevention Strategies of Otitis Externa

Abstract

Otitis externa is an inflammation of the external ear that can be infectious or noninfectious. It is classified into acute, chronic, diffuse, and malignant types, commonly caused by bacterial, fungal, or viral infections. More than 90 percent of cases are caused by bacteria, particularly Pseudomonas aeruginosa and Staphylococcus aureus, while fungal infections are most commonly caused by Aspergillus and Candida species. The main predisposing factor is swimming, which increases the risk up to five times compared to non-swimmers. Other risk factors include humid environments, excessive ear cleaning, prolonged antibiotic use, immunosuppression, diabetes mellitus, and narrowing of the ear canal or the presence of foreign bodies. The pathophysiology begins with disruption of the protective cerumen layer, leading to increased pH and loss of its hydrophobic function, which facilitates water retention and microbial growth. This process triggers inflammation in the thin and vulnerable epithelium of the ear canal. Common clinical features include ear pain that worsens with tragal pressure, itching, discharge, edema, erythema, and conductive hearing loss. Diagnosis is established through history taking, otoscopic examination, and supporting tests such as audiometry and culture in selected cases. Management includes ear canal cleaning, analgesics, topical antibiotics, and systemic therapy in severe cases. Prevention focuses on maintaining ear hygiene, avoiding trauma, and controlling risk factors. Proper management can reduce recurrence, prevent complications, and improve clinical outcomes.