Otitis Externa (cont.)

Chronic (long-term) swimmer's ear is otitis externa that persists for longer than four weeks or that occurs more than four times a year. This condition can be caused by a bacterial infection, a skin condition (eczema or seborrhea), fungus (Aspergillosis), chronic irritation (such as from the use of hearing aids, insertion of cotton swabs, etc), allergy, chronic drainage from middle ear disease, tumors (rare), or it may simply follow from a nervous habit of frequently scratching the ear. In some people, more than one factor may be involved. For example, a person with eczema may subsequently develop black ear drainage. This would suggest of an accompanying fungal infection.

The standard treatments and preventative measures, as noted below, are often all that is needed to treat even a case of chronic otitis externa. However, in people with diabetes or those with suppressed immune systems, chronic swimmer's ear can become a serious disease (malignant external otitis). Malignant external otitis is a misnomer because it is not a tumor or a cancer, but rather an aggressive bacterial (typically Pseudomonas) infection of the base of the skull.

Regardless of the cause, moisture and irritation will prolong the course of the problem. For this reason, the ear should be kept dry. While showering or swimming use an ear plug (one that is designed to keep water out), or use cotton with Vaseline on the outside.

Scratching the inside of the ear or using cotton swabs should be avoided. This will only aggravate the irritated skin, and in most situations will make the condition worse. In fact, scratching the inside of the ear will just make the ear itch more, and any medications prescribed will be ineffective. A hearing aid should be left out as much as possible until swelling and discharge stops.

The most common treatment consists of ear drops containing antibiotics or antibiotics with corticosteroids to reduce inflammation. Oral antibiotics may also be required in some cases. These should be used as directed. In some situations, a "wick" will need to be placed in the ear canal to stent it open and serve as a conduit for the ear drops. Periodic, and sometimes frequent, suctioning of the ear canal helps to keep it open, remove debris, and decrease bacterial counts.

Pain-relieving medications such as acetaminophen or antihistamines to decrease itching may also be recommended along with antibiotics.

Source: MedicineNet.com
http://www.medicinenet.com/otitis_externa/article.htm