14 September 2015

Answer: What's your diagnosis? – Case 28

Mr T has a very painful left ear, which started shortly after swimming in a heated pool. Based on his history, he is most likely suffering from a very painful condition called 'otits externa' (outer ear infection).


Otits externa is a painful condition where the external ear canal gets infected.

Also known as swimmer's ear, this condition often results from swimming in pools where the water is not very clean. Heated swimming pools are particularly notorious as the warm water environment is perfect for organisms to grow in. Occasionally, otits externa can also be caused by water trapped in the ear canal after showering.

Using any sharp objects to clean the ear canal adds to the possibility of suffering from a case of otits externa. When the sensitive ear canal is damaged (even with a slight scratch), organisms can cause inflammation and infection that can rapidly progress to full blown infection.

The most common causative organism is pseudomonas.

Signs and symptoms

Otits externa is a very painful condition and patients often present with significant pain as the only symptom. In most cases patients will report a discharge from the ear canal. In early stages of the condition, patients report a itchy sensation. Scratching the ear canal makes matters worse.

Read: What are the possible causes of foul-smelling ears?

On examination, the ear canal is often severely swollen. In severe cases it is almost impossible to look down the canal with a otoscope. The ear canal may appear red, irritated and a discharge is present. Some people report that the ear canal looks like it "sheds skin". This is because of the discharge, infection and inflammation.

Pressing on the tragus (the small tab just in front of the ear canal opening, worsens the pain. This is a very important clue in diagnosing the condition.

Treating otits externa

Antibiotic ear drops is the cornerstone for treating significant infection. Often the drops will also contain anti-inflammatory drugs that will help reduce swelling and inflammation. Oral antibiotics is not first line treatment as the dosage of medication that reaches the ear canal is often sub-optimal. In severe cases referral to an ENT surgeon is warranted.

NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis? -  Case 1: vomiting and weight loss

What's your diagnosis? -  Case 2: eye pain

What's your diagnosis? -  Case 3: strange behaviour and a bullet in the back

What's your diagnosis? -  Case 4: seeing odd things

What's your diagnosis? - Case 5: mysterious lungs

What's your diagnosis? - Case 6: runner with seizures

What's your diagnosis? - Case 7: swollen knee

What's your diagnosis? - Case 8: bloody semen

What's your diagnosis? - Case 9: confusing neurological signs

What's your diagnosis? - Case 10: diabetic teenager with unusual signs and symptoms

What's your diagnosis? - Case 11: bruising with no apparent reason

What's your diagnosis? - Case 12: severe tummy pain

What's your diagnosis? - Case 13: severe sore throat

What's your diagnosis? - Case 14: abdominal pain and swelling

What's your diagnosis? - Case 15: the world is spinning

What's your diagnosis? - Case 16: numbness in forearm

What's your diagnosis? - Case 17: burning urine

What's your diagnosis? - Case 18: boy with persistent fever

What's your diagnosis? – Case 19: lady who can't lose weight

What's your diagnosis? – Case 20: chest pain next to breastbone

What's your diagnosis? – Case 21: burning sensation in vagina

What's your diagnosis? – Case 22: vomiting and headaches

What's your diagnosis? – Case 23: frequent urination

What's your diagnosis? – Case 24: painful and swollen leg

What's your diagnosis? – Case 25: swollen knee and fever

What's your diagnosis? – Case 26: swelling of face

What's your diagnosis? – Case 27: sudden, severe leg pain

Dr. Owen J. Wiese is Health24's resident doctor. After graduating from Stellenbosch University with additional qualifications in biochemistry and physiology he developed a keen interest in providing medical information through the media.


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