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==Overview==
The primary cause of otitis externa is [[bacterial]]; the majority of cases result from ''[[Pseudomonas aeruginosa]]'' or ''[[Staphylococcus aureus]]'' infections. [[Otomycosis]] can cause otitis externa with primary infectious [[fungi]] including ''[[Candida albicans]]'' and ''[[Aspergillus niger]]''. [[Allergy]]-caused [[dermatitis]] can cause non-infectious otitis externa if it spreads to the [[ear canal]]; this includes [[inflammatory]] [[dermatoses]] such as [[eczema]], [[seborrhea]], and [[psoriasis]]. [[Contact dermatitis]] can cause otitis externa from allergic reactions to cosmetic chemicals and metals. Rarely, [[psoriasis]] therapy [[secukinumab]] can cause otitis externa as an adverse reaction.


==Causes==
==Causes==
The two factors that are required for external otitis to develop are (1) the presence of [[Pathogen|germs]] that can infect the skin and (2) impairments in the integrity of the skin of the ear canal that allow [[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 sewage, is likely to set off an episode. However, if there are chronic skin conditions that affect the ear canal skin, such as [[atopic dermatitis]], seborrheic dermatitis, [[psoriasis]] or abnormalities of [[keratin]] 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.
Causes of otitis externa include all sources of [[Inflammation|inflammation]] of the external [[ear canal]].<ref name="pmid19450296">{{cite journal |vauthors=Hajioff D, Mackeith S |title=Otitis externa |journal=BMJ Clin Evid |volume=2008 |issue= |pages= |year=2008 |pmid=19450296 |pmc=2907945 |doi= |url=}}</ref>


The most common [[bacterial]] pathogens causing otitis externa are ''[[Pseudomonas aeruginosa]]'' and ''[[Staphylococcus aureus]]'', followed by a great number of other gram-positive and gram-negative species.<ref>{{cite journal | author = Roland P, Stroman D | title = Microbiology of acute otitis externa. | journal = Laryngoscope | volume = 112 | issue = 7 Pt 1| pages = 1166-77 | year = 2002 | id = PMID 12169893}}</ref> ''[[Candida albicans]]'' and ''[[Aspergillus]]'' species are the most common fungal pathogens responsible for the condition.
===Bacterial===
*The most common [[bacterial]] causes of otitis externa include:<ref name="WilliamsGillespie2010">{{cite journal|last1=Williams|first1=K. P.|last2=Gillespie|first2=J. J.|last3=Sobral|first3=B. W. S.|last4=Nordberg|first4=E. K.|last5=Snyder|first5=E. E.|last6=Shallom|first6=J. M.|last7=Dickerman|first7=A. W.|title=Phylogeny of Gammaproteobacteria|journal=Journal of Bacteriology|volume=192|issue=9|year=2010|pages=2305–2314|issn=0021-9193|doi=10.1128/JB.01480-09}}</ref>
**''[[Pseudomonas aeruginosa]]''<ref name="WilliamsGillespie2010">{{cite journal|last1=Williams|first1=K. P.|last2=Gillespie|first2=J. J.|last3=Sobral|first3=B. W. S.|last4=Nordberg|first4=E. K.|last5=Snyder|first5=E. E.|last6=Shallom|first6=J. M.|last7=Dickerman|first7=A. W.|title=Phylogeny of Gammaproteobacteria|journal=Journal of Bacteriology|volume=192|issue=9|year=2010|pages=2305–2314|issn=0021-9193|doi=10.1128/JB.01480-09}}</ref>
**''[[Staphylococcus aureus|Staphylococcus aureus]]''
*Additional [[bacterial]] causes of otitis externa include:<ref name="pmid12169893">{{cite journal |vauthors=Roland PS, Stroman DW |title=Microbiology of acute otitis externa |journal=Laryngoscope |volume=112 |issue=7 Pt 1 |pages=1166–77 |year=2002 |pmid=12169893 |doi=10.1097/00005537-200207000-00005 |url=}}</ref>
**''[[Staphylococcus epidermidis]]''
**''Microbacterium otitidis''
**''Microbacterium alconae''
**''[[Staphylococcus caprae]]''
**''Staphylococcus auricularis''
**''[[Enterococcus faecalis]]''
**''[[Enterobacter cloacae]]''
**''Staphylococcus capitis''
**''[[Staphylococcus haemolyticus]]''
*Infectious [[bacteria]] that thrive in water can cause otitis externa due to facilitated transport to the [[ear canal]].<ref name="urlSwimmers ear : MedlinePlus Medical Encyclopedia">{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/000622.htm |title=Swimmer's ear : MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>


[[Fungal]] ear canal infections, also known as [[otomycosis]], range from inconsequential to very severe. Fungus can be saprophytic, in which there are no symptoms and the fungus simply co-exists in the ear canal in a harmless parasitic relationship with the host, in which case the only physical finding is presence of the fungus. If for any reason 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 fungal infection worse. Prolonged use of them promotes growth of fungus in the ear canal.
===Fungal===
*[[Otomycosis]] can cause otitis externa. The most common causes of fungal otitis externa include:<ref name="RosenfeldBrown2006">{{cite journal|last1=Rosenfeld|first1=R|last2=Brown|first2=L|last3=Cannon|first3=C|last4=Dolor|first4=R|last5=Ganiats|first5=T|last6=Hannley|first6=M|last7=Kokemueller|first7=P|last8=Marcy|first8=S|last9=Roland|first9=P|last10=Shiffman|first10=R|title=Clinical practice guideline: Acute otitis externa|journal=Otolaryngology - Head and Neck Surgery|volume=134|issue=4|year=2006|pages=S4–S23|issn=01945998|doi=10.1016/j.otohns.2006.02.014}}</ref>
**''[[Candida albicans]]''
**''[[Aspergillus niger]]''
*[[Otomycosis]]-caused otitis externa is common after prolonged antibiotic therapy.<ref name="pmid19450296">{{cite journal |vauthors=Hajioff D, Mackeith S |title=Otitis externa |journal=BMJ Clin Evid |volume=2008 |issue= |pages= |year=2008 |pmid=19450296 |pmc=2907945 |doi= |url=}}</ref>
 
===Allergic Reactions===
*[[Allergy]]-caused [[dermatitis]] can cause non-infectious otitis externa if they spread to the [[ear canal]] and include the following:<ref name="RosenfeldBrown2006">{{cite journal|last1=Rosenfeld|first1=R|last2=Brown|first2=L|last3=Cannon|first3=C|last4=Dolor|first4=R|last5=Ganiats|first5=T|last6=Hannley|first6=M|last7=Kokemueller|first7=P|last8=Marcy|first8=S|last9=Roland|first9=P|last10=Shiffman|first10=R|title=Clinical practice guideline: Acute otitis externa|journal=Otolaryngology - Head and Neck Surgery|volume=134|issue=4|year=2006|pages=S4–S23|issn=01945998|doi=10.1016/j.otohns.2006.02.014}}</ref>
**[[Eczema]]
**[[Seborrhea]]
**[[Psoriasis]]<ref>Kang K, Stevens SR. Pathophysiology of atopic dermatitis. Clin Dermatol 2003;21:116–121.</ref>
**[[Contact dermatitis]] as a reaction to the following:
***Metals such as nickel or silver
***Hearing aids
***Chemical irritants, including shampoos, soaps, cosmetics etc.,
 
===Drug interaction===
*Rarely, [[psoriasis]] therapy [[secukinumab]] can cause otitis externa as an adverse reaction.<ref name="urlDailyMed - COSENTYX- secukinumab injection">{{cite web |url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=77c4b13e-7df3-42d4-81db-3d0cddb7f67a |title=DailyMed - COSENTYX- secukinumab injection |format= |work= |accessdate=}}</ref>
 
===Causes by Chronicity===
====Chronic Otitis Externa====
*Chronic otitis externa is most commonly caused by the following:
**[[Otomycosis]], particularly by ''[[Candida albicans]]'' and ''[[Aspergillus niger]]''
**Allergic [[rhinitis]]
**Underlying [[dermatoses]]:
***[[Eczema]]
***[[Seborrhea]]
***[[Psoriasis]]
***[[Contact dermatitis]]
====Acute Otitis Externa====
**Primarily caused by [[bacterial]] infection of ''[[Pseudomonas aeruginosa]]'' and ''[[Staphylococcus aureus|Staphylococcus aureus]]''.<ref name="pmid23198673">{{cite journal |vauthors=Schaefer P, Baugh RF |title=Acute otitis externa: an update |journal=Am Fam Physician |volume=86 |issue=11 |pages=1055–61 |year=2012 |pmid=23198673 |doi= |url=}}</ref>


==References==
==References==
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Latest revision as of 23:29, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.; Tarek Nafee, M.D. [2]

Overview

The primary cause of otitis externa is bacterial; the majority of cases result from Pseudomonas aeruginosa or Staphylococcus aureus infections. Otomycosis can cause otitis externa with primary infectious fungi including Candida albicans and Aspergillus niger. Allergy-caused dermatitis can cause non-infectious otitis externa if it spreads to the ear canal; this includes inflammatory dermatoses such as eczema, seborrhea, and psoriasis. Contact dermatitis can cause otitis externa from allergic reactions to cosmetic chemicals and metals. Rarely, psoriasis therapy secukinumab can cause otitis externa as an adverse reaction.

Causes

Causes of otitis externa include all sources of inflammation of the external ear canal.[1]

Bacterial

Fungal

Allergic Reactions

Drug interaction

Causes by Chronicity

Chronic Otitis Externa

Acute Otitis Externa

References

  1. ↑ 1.0 1.1 Hajioff D, Mackeith S (2008). "Otitis externa". BMJ Clin Evid. 2008. PMC 2907945. PMID 19450296.
  2. ↑ 2.0 2.1 Williams, K. P.; Gillespie, J. J.; Sobral, B. W. S.; Nordberg, E. K.; Snyder, E. E.; Shallom, J. M.; Dickerman, A. W. (2010). "Phylogeny of Gammaproteobacteria". Journal of Bacteriology. 192 (9): 2305–2314. doi:10.1128/JB.01480-09. ISSN 0021-9193.
  3. ↑ Roland PS, Stroman DW (2002). "Microbiology of acute otitis externa". Laryngoscope. 112 (7 Pt 1): 1166–77. doi:10.1097/00005537-200207000-00005. PMID 12169893.
  4. ↑ "Swimmer's ear : MedlinePlus Medical Encyclopedia".
  5. ↑ 5.0 5.1 Rosenfeld, R; Brown, L; Cannon, C; Dolor, R; Ganiats, T; Hannley, M; Kokemueller, P; Marcy, S; Roland, P; Shiffman, R (2006). "Clinical practice guideline: Acute otitis externa". Otolaryngology - Head and Neck Surgery. 134 (4): S4–S23. doi:10.1016/j.otohns.2006.02.014. ISSN 0194-5998.
  6. ↑ Kang K, Stevens SR. Pathophysiology of atopic dermatitis. Clin Dermatol 2003;21:116–121.
  7. ↑ "DailyMed - COSENTYX- secukinumab injection".
  8. ↑ Schaefer P, Baugh RF (2012). "Acute otitis externa: an update". Am Fam Physician. 86 (11): 1055–61. PMID 23198673.

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