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To the Editor.—Recurrent otitis externa is an all-too-frequent problem in most patients seen by otolaryngologists. Many patients are seen who do not have evidence of eczematoid-type chronic otitis externa, or any other clear-cut cause of their recurrent bouts of otitis externa. After routine treatment with multiple courses of otic solutions, I have found that a significant number of patients will benefit from using ear plugs when bathing, as I am sure many other otolaryngologists have also found. However, I have found that a common thread links all those patients who benefit from water protection when bathing. Specifically, they all wash their hair in the shower with their head tilted backward rather than forward. When the head is tipped backward, the outer ear acts as a funnel allowing water to flow into the external auditory canal and, in turn, leading to maceration of the skin. All these patients have been
SHAPIRO DP. Recurrent Otitis Externa. Arch Otolaryngol Head Neck Surg. 1989;115(3):394. doi:10.1001/archotol.1989.01860270136034