Otitis externa: What clinicians need to hear: pathophysiology, management and treatment

Abstract

Otitis externa is a common inflammatory condition affecting the external auditory canal (EAC), characterised by symptoms such as otalgia (ear pain), pruritus (itching), erythema (redness), and otorrhoea (discharge), with a higher incidence in warm and humid environments. The condition may be classified as acute, chronic, or necrotising, with diagnosis primarily based on clinical evaluation and otoscopic examination. The pathophysiology involves disruption of the protective barrier of the ear canal, subsequent microbial colonisation, and host immune responses. Management strategies include both non-pharmacological measures, such as ear canal care (e.g. dry mopping) and moisture avoidance, as well as pharmacological interventions, including topical antimicrobial and anti-inflammatory agents. Systemic therapy is reserved for severe or complicated infections. Key challenges in the management of otitis externa include antimicrobial resistance, appropriate antimicrobial selection, patient adherence, and limited access to specialist care in resource-limited settings. Further research is required to optimise therapeutic strategies, strengthen antimicrobial stewardship, and improve clinical outcomes.