How Should Swimmer's Ear (Acute Otitis Externa) Be Managed?

Judith S. Lynch, MS, MA, APRN-BC


July 01, 2011

In This Article

Signs and Symptoms of AOE

AOE is an extremely painful condition. It typically has a rapid onset with the following symptoms:

  • Pruritis and/or otalgia;

  • Fullness with/without hearing loss;

  • Otorrhea (clear and odorless);

  • Tenderness of pinna and/or tragus, especially when pressure is applied to the area;

  • Diffuse canal edema/erythema; and

  • Regional lymphadenopathy.

If untreated, pruritis, otalgia, and erythema become more pronounced. Often, mucopurulent drainage with decreased or muffled hearing is present. Symptoms can progress to severe pain radiating into the face, neck, or mastoid area. Complete ear blockage from edema, erythema of the auricle, fever, and mastoid tenderness are possible. This may progress to necrotizing OE requiring hospitalization.[4]

Physical Examination of AOE

Testing for preauricular and mastoid tenderness should be done, and a complete otologic examination is essential. However, it is important to gently use the otoscope in the presence of edema and erythema because this will cause excessive pain. Although it is necessary to visualize the tympanic membrane, it is easier to treat the patient's pain first and recheck the area in 48-72 hours to rule out otitis media. Check for lymphadenopathy. Nodes on the affected side will often be enlarged and tender.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: