The infection may extend to cranial nerves, or rarely to the meninges or brain. Examination of the ear canal may reveal granulation tissue in the inferior canal. It is treated with several weeks of IV and oral antibiotics, usually fluoroquinolones. Mechanical obstruction
Earwax impaction: results in 12 million medical visits annually in the United States. Cerumen impaction may cause ear pain, but it can also prevent thorough examination of the ear and identification of an alternate source of pain. Foreign body: commonly include insects or small objects like beads

Less common
Herpes zoster: varicella zoster virus can reactivate in an area that includes the ear. Reactivation can produce pain and visible vesicles within the ear canal and, when combined with facial paralysis due to facial nerve involvement, is called Ramsay Hunt syndrome. Tumors: the most common ear canal tumor is squamous cell carcinoma. Symptoms can resemble those of otitis externa, and cancer should be considered if the symptoms are not improving on appropriate treatment. Middle and inner ear
Acute otitis media
Acute otitis media is an infection of the middle ear. More than 80% of children experience at least one episode of otitis media by age 3 years. Acute otitis media is also most common in these first 3 years of life, though older children may also experience it. The most common causative bacteria are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Otitis media often occurs with or following cold symptoms.
Lumacaftor/ivacaftor, sold under the brand name Orkambi among others, is a combination of lumacaftor and ivacaftor used to treat people with cystic fibrosis who have two copies of the F508del mutation. It is unclear if it is useful in cystic fibrosis due to other causes. It is taken by mouth.Common side effects include shortness of breath, nausea, diarrhea, feeling tired, hearing problems, and rash. Severe side effects may include liver problems and cataracts. Ivacaftor increases the activity of the CFTR protein, while lumacaftor improves protein folding of the CFTR protein.It was approved for medical use in the United States in 2015, and in Canada in 2016. In the United States it costs more than $US 22,000 a month as of 2018. While its use was not recommended in the United Kingdom as of 2018, pricing was agreed upon in 2019 and it is expected to be covered by November of that year. Medical use
The combination of lumacaftor/ivacaftor is used to treat people with cystic fibrosis who have two copies of the F508del mutation in the cystic fibrosis transmembrane conductance regulator (CFTR), the defective protein that causes the disease. This genetic abnormality is present in about half of cystic fibrosis cases in Canada. Its use is not recommended for anyone with cystic fibrosis in the United Kingdom as of 2018.While the medication resulted in improvement in the amount of air a person can breathe out in one second, the improvement seen did not reach a clinically important amount.