Otitis: external, medium and labyrinthitis

Otitis is an inflammatory process affecting the ear. In accordance with the anatomy of the ear, otitis is divided into external otitis, otitis media, labyrinthitis

Acute otitis externa (AOE), causes and symptoms and prevention

Acute otitis externa includes inflammatory or infectious processes of the external auditory canal, usually in an acute form, i.e. limited to episodes that do not last long.

It is referred to as ‘swimmer’s otitis’ as it strikes mainly in summer

Sweat, excessive humidity, chlorine, polluted water, water-stained skin are, in fact, the ideal conditions for bacteria living on the skin of the external auditory canal.


But that’s not all: among the causes of external otitis, microtrauma is also a non-negligible factor.

For this reason, it is important to clean the ears gently, taking great care when using cotton buds, which can irritate and cause inflammation.

Sometimes otitis externa can be related to otitis media or upper respiratory tract infections or be secondary to dermatitis (eczema) without associated microbial infection or be caused by a bacterial or fungal infection.

The typical symptoms of otitis externa usually have a rapid onset and are otalgia (often severe earache), a ‘plugged’ (closed ear) sensation, itching and/or the discharge of a usually yellow, pus-like discharge.

The diagnosis of otitis externa is made by the doctor after a physical examination has revealed swelling and redness of the organ.

The ear canal may appear as if affected by eczema and palpation of the outer ear increases the pain.

If the use of an otoscope proves difficult, the doctor can collect material from the ear and have it cultured to find out which bacteria or fungi have caused the otitis.

Treatment in cases of otitis externa is based on treating the infection by administering topical antibiotics and corticosteroids.

Various topical drugs are commercially available, usually in the form of drops to be applied directly into the ear so that they act immediately on the infected part.

In the case of an obstruction of the ear canal, the passage of the medication should be facilitated by thoroughly cleaning the ear, which should be cleansed of inflammatory residues and earwax.

It is always important to consult a specialist to assess that the eardrum membrane is intact: cleaning the ear can be risky in certain cases.

Analgesic treatment to soothe pain may be combined with antibiotic therapy or corticosteroids

There is no real prevention of otitis externa, especially for those patients who suffer from skin diseases (contact dermatitis, seborrhoeic dermatitis) and are therefore more exposed to these infections.

In general, it is important to remember that earwax constitutes an important protective barrier against moisture; it also creates a slightly acidic Ph that inhibits the development of infections.

Soap deposits, water, alkaline ear drops can alter earwax: therefore, excessive cleaning of the external ear canal is not recommended.

In particular, in cases of acute external otitis earwax cleaning cones should not be used.

Instead, it is recommended to use earplugs when diving and to dry the ears well to avoid stagnating liquids and damp conditions.

Otitis media (OMA), causes and symptoms and prevention

Acute otitis media is the inflammation of the middle ear located immediately after the tympanic membrane, caused by bacteria or viruses (among which, the most frequent pathogens are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes).

It is one of the most common bacterial infections in childhood: according to several authors, episodes of acute otitis media occur in more than 80% of children under the age of three.

Persons with Down’s syndrome and allergic individuals, particularly males, may be considered to be at greater risk of contracting otitis media.

The development of acute otitis media is favoured by a number of factors: dysfunction of the Eustachian tube, male sex, poor pneumatisation of the mastoid, genetic predisposition, artificial breast-feeding, attendance at crowded nurseries or kindergartens, suboptimal hygienic conditions, and exposure to second-hand smoke.

It is often associated with an upper airway infection.

Typical symptoms of otitis media are irritability and difficulty eating and sleeping, earache, increased blood pressure in the organ, conductive hearing loss and sometimes, if there is perforation of the tympanic membrane, otorrhea.

There may be associated symptoms such as fever, cough and runny nose.

In severe cases, the blood pressure may be so great that the tympanic membrane ruptures.

Even before the appropriate medical treatment, the correct diagnostic picture (not always easy, especially in children) is crucial when faced with referred ear pain.

The treatment of otitis media is closely related to the treatment of otalgia and is essentially based on the administration of analgesics to soothe the earache.

When symptoms persist or worsen, antibiotic treatment must also be administered in children.


Labyrinthitis is an inflammation of the labyrinth caused by viral infection (usually secondary to systemic infection) or bacterial infection (consequence of meningitis and otitis media).

Both forms are characterised by hearing loss and dizziness.

In the bacterial forms, sensorineural hearing loss is aggravating and generally severe-deep and permanent, accompanied in some cases by sudden rotatory vertigo syndrome that may last for several days.

Viral forms affect the inner ear less severely than bacterial forms and typically manifest with sudden hearing loss of varying degrees associated with vertigo.

Smoking, allergies and alcohol abuse are considered risk factors for labyrinthitis.

From a therapeutic point of view, in cases of labyrinthitis, the outbreak is treated with targeted antibiotics.

Surgery on the labyrinth is only planned after careful evaluation of anamnestic, clinical and radiographic data when signs of meningitis appear and when the anterior and posterior labyrinths appear severely damaged on functional testing.

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