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Otitis externa (OE) is an inflammation, that can be either infectious or non-infectious, of the external auditory canal. In some cases, inflammation can extend to the outer ear, such as the pinna or tragus. OE can be classified as acute (lasts less than 6 weeks) or chronic (lasts more than 3 months). It is also known as swimmer's ear as it often occurs during the summer and in tropical climates and having retained water in the ears increases the risk for it. The most common cause of acute otitis externa is a bacterial infection. It may be associated with allergies, eczema, and psoriasis.
Pseudomonas aeruginosa and Staphylococcus aureus are the most common pathogens involved in otitis externa. Otitis externa can also occur as a polymicrobial infection, and rarely, it may result from a fungal infection such as Candida or Aspergillus. Various factors can predispose patients to the development of OE. Swimming is one of the most common risk factors, and it increases the risk five times when compared to non-swimmers. Other risk factors include:[1]
Trauma or external devices (cotton swabs, earplugs, hearing aids) Dermatologic conditions such as eczema and psoriasis Ear canal obstruction (cerumen obstruction, foreign body)The two most characteristic presenting symptoms of otitis externa are otalgia (ear discomfort) and otorrhea (discharge in or coming from the external auditory canal). 2 The ear discomfort can range from pruritus to severe pain that is exacerbated by motion of the ear, including chewing. If inflammation causes sufficient swelling to occlude the external auditory canal, the patient may also complain of aural fullness and loss of hearing. 6 – 8 Otorrhea is also quite variable. Its characteristics often may give a clue to its etiology (Table 2). 4 , 6 , 9 – 11
Otorrhea and other debris can occlude the ear canal. Such occlusion makes it difficult to visualize the tympanic membrane and exclude otitis media, it also keeps the canal moist and interferes with topical treatment. It is imperative that this material be removed. However, inflammation makes the external auditory canal even more vulnerable to trauma than usual, and therefore the use of a cerumen spoon or curette should be avoided. Cleansing is best done by suctioning under direct visualization, using the open or operating otoscope head and a 5 or 7 Fr Frazier malleable suction tip attached to low suction. Alternatively, a cotton swab with the cotton fluffed out can be used to gently mop out thin secretions from the external auditory canal, again under direct visualization (Figure 2).
If the secretions are thick, crusted or adherent, instillation of antibiotic drops or hydrogen peroxide may help to soften them for removal. 6 , 7 , 9 Some authors 10 advocate instillation of alcohol afterward to dry the canal, but this may be too irritating if the canal is already inflamed.
Unless the tympanic membrane can be fully observed and is found to be intact, flushing of the ear canal should not be attempted. A small perforation is often missed, and a tympanic membrane already weakened by infection can easily be disrupted. Divers, surfers and others who experience forceful compression of the tympanic membrane are particularly susceptible to perforations. 5 , 12 Flushing the ear when the tympanic membrane is perforated can disrupt the ossicles and cause significant cochlear-vestibular damage, resulting in hearing loss, tinnitus, vertigo and dizziness. Such damage may necessitate surgery, and a perforated tympanic membrane associated with flushing is a common cause of litigation. 13 , 14 In addition, flushing may cause further trauma to the ear canal.
Een ‘zwemmersoor’ (Otitis Externa) is een ontsteking of infectie van de uitwendige gehoorgang, het holletje dat van je oorschelp tot aan het trommelvlies loopt.
De oorzaak van de infectie is gewoonlijk een bacterie of soms een schimmel die de gevoelige wand van de gehoorgang aantast. Die huid kan gemakkelijk geïrriteerd of gekwetst raken, bijvoorbeeld door in het oor te peuteren . Een klein sneetje is voldoende voor een besmetting als er toevallig ook een kwaadaardige bacterie of schimmel in de buurt is. Ook haarsprays en haarkleurmiddelen kunnen de gehoorgang irriteren en vatbaar maken voor infecties. Verder kan het langdurig dragen van oordopjes of -watjes zorgen voor het verweken van de gehoorgang.
Een andere belangrijke oorzaak van zwemmersoor is te veel vocht in het oor . Dit doet de huid in de gehoorgang zwellen, wat ze week maakt. Wanneer ze opdroogt, wordt ze vaak wat minder soepel en korstig, waardoor ze gevoeliger wordt voor besmettingen. Mensen die veel zwemmen, hebben er gemakkelijker last van. Vandaar trouwens de populaire naam ‘zwemmersoor’. Ook occasioneel zwemmen in vervuild water kan de oorzaak zijn.
Is uw oor van buiten dik en voelt u zich ziek? Dan heeft u misschien ook pillen tegen bacteriën (antibiotica) nodig. Deze pillen moet u slikken. Ga ook door met de oordruppels.