Acute Otitis Externa Complications

Acute Otitis Externa (Swimmer’s Ear): Complications
Acute Otitis Externa (AOE)
Authors: Charmaine Szalay-Anderson Vaneeza Moosa Reviewers: Shayan Hemmati Shahab Marzoughi Ben Campbell Justin Lui* * MD at time of publication
Spread to subcutaneous tissue
Chronic otitis externa (>6 weeks)
Chronic inflammation of the outer ear
Fibroblast activation for collagen and extracellular matrix components production for tissue repair
Excess accumulation of tissue
Ear canal fibrosis (thickening)
Ear canal stenosis (narrowing)
Damage/obstruction to ear canal structures with impaired fluid drainage & pressure buildup
Inflammation of the outer ear
Recurrent or non-resolving acute otitis externa Dissemination of infection
Spread to connective tissue and cartilage
Perichondritis (inflammation of ear cartilage)
Spread of Pseudomonas aeruginosa
in an immunocompromised host or due to antibiotic resistance
Rapid infectious spread through soft tissue to mastoid and/or temporal bone
Malignant (necrotizing) otitis externa *can be life threatening
Inflammation of connective tissue and bony structures
Spread to
tympanic membrane
Myringitis (inflammation of tympanic membrane)
Swelling and thinning of tissue
Tympanic membrane perforation (tear)
Immune reaction with inflammation
Dead white blood cell, bacteria & tissue debris accumulation in the ear canal
Pus formation with purulent otorrhea (discharge from ear)
Localized pus accumulation
Ear canal blockage
Periauricular/ pinna (outer ear) cellulitis
Facial cellulitis
Erosion of temporal bone decreasing bony sound conduction
Permanent conductive hearing loss
Direct toxicity of pathogens to surrounding nerves
Cranial nerve (CN) VII (facial) palsy (+/- CN X, XI, XII)
Out-of- proportion primary otalgia (ear pain)
Sensation of fullness in the ear
Temporary hearing loss
Sign/Symptom/Lab Finding
Published Dec 4, 2022; updated Feb 7, 2024 on