Published: 2021-11-24

Epidemiology, risk factors and monitoring of acute otitis externa

Shada O. Baoum, Ali A. Bin Mousa, Moudhi Y. Alshammari, Zahraa S. Alzaher, Hasan M. Zahrani, Ahmed H. Alhammad, Hajar M. Alsobhan, Abdullah A. Aleidan, Sarah A. Alsalhi, Khaled A. Mansouri, Hassan K. Halawani


Estimates show that otitis externa is a common presentation in different settings and can be acute, chronic, or necrotizing. Eczema of the ear canal is usually associated with the condition. It has also been demonstrated that humid environments, swimming, and mechanical trauma, using hearing aid supplements, and absence or reduce air wax are all significant risk factors that can increase the risk of having otitis externa. The pathology of otitis externa is simply an inflammation of the external auditory canal, which can either be attributed to an infection or other non-infectious etiologies. In the present literature review, we have discussed the epidemiology, risk factors, and monitoring of patients with acute otitis externa. Our findings indicate the high prevalence of the condition, especially among developing countries and areas with high temperature and humidity levels. Swimmers are more commonly affected together with adults. However, children might also be affected in some cases. Male individuals also have a higher risk. Nevertheless, data is limited and further studies are needed. The condition can be easily treated and symptoms usually resolve within 1 day from initiating the treatment. However, some cases might persist, and in these events, consultation with an otolaryngologist is required together with culture for adequate identification of the etiology and management of the case.


Otitis externa, Epidemiology, Prevalence, Swimmer’s disease, Risk factors

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Hajioff D, Mackeith S. Otitis externa. BMJ clinical evidence. 2010;2010.

Wiegand S, Berner R, Schneider A, Lundershausen E, Dietz A. Otitis Externa. Dtsch Arztebl Int. 2019;116(13):224-34.

Weber PC, Roland PS, Hannley M. The development of antibiotic resistant organisms with the use of ototopical medications. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2004;130(3):S89-94.

Kaur R, Mittal N, Kakkar M, Aggarwal AK, Mathur MD. Otomycosis: a clinicomycologic study. Ear, nose, & throat journal. 2000;79(8):606-9.

Neher A, Nagl M, Scholtz AW. Otitis externa: etiology, diagnostic and therapy. Hno. 2008;56(10):1067-79.

Raza SA, Denholm SW, Wong JC. An audit of the management of acute otitis externa in an ENT casualty clinic. The Journal of laryngology and otology. 1995;109(2):130-3.

Hajioff D, MacKeith S. Otitis externa. BMJ clinical evidence. 2015;2015.

van Balen FA, Smit WM, Zuithoff NP, Verheij TJ. Clinical efficacy of three common treatments in acute otitis externa in primary care: randomised controlled trial. Bmj. 2003;327(7425):1201-05.

Mustafa M, Patawari P, Sien M, Muniandy R, Zinatara P. Acute otitis externa: pathophysiology, clinical presentation and treatment. J Dent Med Sci. 2015;14:73-8.

Adegbiji WA, Aremu SK, Olatoke F, Olajuyin AO, Ogundipe K. Epidemiology Of Otitis Externa In Developing Country. 2017.

Uju IM, Nosa OE. Otologic diseases in a tertiary hospital in the Niger Delta region of Nigeria. 2013.

Fasunla AJ, Samdi M, Nwaorgu OG. An audit of ear, nose and throat diseases in a tertiary health institution in South-western Nigeria. The Pan African medical journal. 2013;14:1.

Nussinovitch M, Rimon A, Volovitz B, Raveh E, Prais D, Amir J. Cotton-tip applicators as a leading cause of otitis externa. International journal of pediatric otorhinolaryngology. 2004;68(4):433-5.

Wingelaar TT, van Ooij PA, van Hulst RA. Otitis externa in military divers: more frequent and less harmful than reported. Diving and hyperbaric medicine. 2017;47(1):4-8.

Chin RY, Nguyen TB. Synchronous malignant otitis externa and squamous cell carcinoma of the external auditory canal. Case reports in otolaryngology. 2013;2013:837169.

Kohli C, Kadirvelu U, Garg S, Sharma N. Burden of ear morbidities among children in primary care setting in Delhi. Clinical Epidemiology and Global Health. 2016;4:S12-6.

Illing E, Zolotar M, Ross E, Olaleye O, Molony N. Malignant otitis externa with skull base osteomyelitis. Journal of surgical case reports. 2011;2011(5):6.

Son PT, Reda A, Viet DC. Exchange transfusion in the management of critical pertussis in young infants: a case series. Vox Sang. 2021.

Roland PS, Stroman DW. Microbiology of acute otitis externa. The Laryngoscope. 2002;112(7):1166-77.

Schaefer P, Baugh RF. Acute otitis externa: an update. American family physician. 2012;86(11):1055-61.

Rosenfeld RM, Schwartz SR, Cannon CR. Clinical practice guideline: acute otitis externa. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2014;150(1 Suppl):S1-24.

Ong YK, Chee G. Infections of the external ear. Annals of the Academy of Medicine, Singapore. 2005;34(4):330-4.

Ijaz T, Anjum AA, Aslam S, Raja SA, Khawaja AR, Ijaz S. Microbial profiling and risk factors assessment for Otitis Media and Otitis Externa. Advancements in Life Sciences. 2014;1(4):191-6.

Boustred N. Practical guide to otitis externa. Australian family physician. 1999;28(3):217-21.

Sander R. Otitis externa: a practical guide to treatment and prevention. American family physician. 2001;63(5):927-936, 941-22.

El-Qushayri AE, Dahy A, Reda A. A closer look to the high burden of the psychiatric disorders among health care workers (HCWs) in Egypt during COVID-19 outbreak: A meta-analysis of 3137 HCWs. Epidemiology and health. 2021:e2021045.

El-Qushayri AE, Ghozy S, Reda A, Kamel AMA, Abbas AS, Dmytriw AA. The impact of Parkinson's disease on manifestations and outcomes of Covid-19 patients: A systematic review and meta-analysis. Rev Med Virol. 2021:e2278.

Thieu H, Bach Dat B, Nam NH. Antibiotic resistance of Helicobacter pylori infection in a children's hospital in Vietnam: prevalence and associated factors. Minerva medica. 2020;111(5):498-501.

Wipperman J. Otitis externa. Primary care. 2014;41(1):1-9.

Medina-Blasini Y, Sharman T. Otitis Externa. In: StatPearls. Treasure Island (FL): StatPearls. 2021.

Rosenfeld RM, Brown L, Cannon CR. Clinical practice guideline: acute otitis externa. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2006;134(4):S4-23.

Kaushik V, Malik T, Saeed SR. Interventions for acute otitis externa. The Cochrane database of systematic reviews. 2010(1):Cd004740.