How can I differentiate between otitis externa and other ear conditions such as otitis media or eczema?

Differentiating otitis externa from otitis media and eczema involves clinical examination and symptom assessment.

• Otitis externa typically presents with intense, severe pain localized to the external ear canal, often worsened by movement of the ear or tragus, and may include swelling, redness, and discharge from the ear canal. The tympanic membrane is usually visible unless obscured by swelling or debris. The pain is due to inflammation of the sensitive skin lining the ear canal close to the periosteum of the bone ¹.
• Otitis media1,³.
• Eczema of the ear canal presents with dry, flaky, or scaly skin, itching, and sometimes redness but usually lacks the severe pain seen in otitis externa. The skin changes may extend beyond the ear canal and can be associated with atopic eczema elsewhere. Persistent or atypical cases may require dermatology referral and patch testing ¹,⁴.
• In otitis externa, the external ear canal is inflamed and may have debris or discharge, whereas in otitis media, the external canal is typically normal, and the pathology is behind the tympanic membrane ¹.
• Visualizing the tympanic membrane is key: if it cannot be seen due to canal swelling or debris, aural toilet or microsuction may be needed to differentiate otitis externa from otitis media or other causes ¹.

Summary: Severe pain on ear canal manipulation, external ear canal swelling, and visible inflammation point to otitis externa. Middle ear signs such as tympanic membrane changes and hearing loss suggest otitis media. Dry, itchy, scaly skin with less pain suggests eczema ¹,³,⁴.