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External ear infection which is also known as external otitis, otitis externa and swimmer's ear, literally refers to the inflammation of the external auditory canal. It happens in all age groups and it is estimated that 10% of people develop external ear infection in their lifetime. It is most frequently seen in summer which could be related to increased humidity and water activities where the name swimmer's ear is coming from.

It is important to understand that the external portion of the auditory canal is made of cartilage and the skin covering it has sweat glands, oil glands and hair follicles whereas the internal part of the canal is made of bone with a very thin covering skin, therefore, any inflammation can cause a lot of pain in this thin skin. This is all meant to say that any sore pimple on the normal hairy skin on the body could also develop in the ear. Therefore, infectious (bacteria, viruses and fungi), allergic and dermatologic diseases may produce a sore pimple in the ear.

As swimmer's ear implies, swimming and water exposure is a known risk factor for otitis externa. Moisture causes the normal cerumen (yellowish waxy secreted substance) to break down. Cerumen has a known protective effect for the ear and its breaking-down leads to overgrowth of bacteria which are not normally present in a normal ear and that ultimately leads to development of bacterial infection which could be presented as a sore pimple.

Trauma of the external ear which frequently happens with aggressive cleaning is also an important cause for infection and inflammation. Trauma causes small tearing within the thin skin covering of the external ear where bacteria find their way to the underlying tissue to cause infection and inflammation. Aggressive cleaning also removes the protective cerumen to make it favorable for overgrowth of unwanted bacteria. Devices that occlude the external ear such as earphones facilitate the development of external otitis.

Allergic reactions can also cause external otitis. It is not uncommon for one to develop allergic reaction to an earring which is sometimes presented as pimples. Allergic reactions can also develop in response to chemicals, air pollution, cosmetics and shampoos.

A large number of dermatologic diseases can produce external otitis. These diseases are also presented in other areas of the body which makes their diagnosis easier. Some of these diseases produce symptoms in organs other than the skin. Psoriasis and atopic dermatitis are two examples of such diseases which can also cause external ear infection.

Patients with a prior history of radiation may develop dermatitis in the external ear but they constitute only a very small portion. Sore pimples of the external ear can also be the heralding presentation of some viruses which tend to hide in nerves and come back years after their initial presentation. Skin cancer can also be rarely presented with similar symptoms. Don't forget to see your doctor and remember that most cases of external ear infections are easily treated by ear drops.

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