A 30-year-old swimming instructor presents with right ear pain and discharge. You examine his ear and can see erythema in the ear canal with copious pus and debris also present.

1. What is the most likely diagnosis?
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The diagnosis, in this case, is otitis externa (swimmer’s ear), which is infection and inflammation of the ear canal. Common symptoms include pain, itching and discharge from the ear. Otoscopy will reveal erythema of the ear canal with pus and debris present.

2. Give two risk factors for developing this condition other than swimming.
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It is more prevalent in people that have regular exposure to water in the ear canal, such as swimmers.

Various other conditions can predispose to otitis externa, including:

  • Congenital narrowing of the ear canal
  • Foreign object in the ear canal, e.g. cotton bud or hearing aid
  • Trauma to the ear canal e.g. overly vigorous cleaning
  • Skin conditions, e.g. eczema or psoriasis
3. What is the commonest causative organism?
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The commonest causative organisms are:

  • Pseudomonas aeruginosa (50%)
  • Staphylococcus aureus (23%)
  • Gram negative bacteria, e.g. E.coli (12%)
  • Aspergillus and Candida species (12%)
4. How is this condition treated?
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It can generally be treated with a topical antibiotic and corticosteroid mix such as Betnesol-N or Sofradex. Occasionally when persistent, it requires referral to ENT for auditory toilet and insertion of an antibiotic-saturated wick.

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