Otitis externa

Overview

Otitis externa, also called swimmer's ear, is an infection or inflammation of the outer ear canal — the tube that leads from the outside of your ear to your eardrum. It happens when water, bacteria, or fungus gets trapped in the ear and causes irritation and swelling.

Yes, otitis externa is a common ear problem, especially in warm, humid climates and during the summer months when people swim more often.

Anyone can get otitis externa, but it is most common in children, teenagers, and people who swim frequently or live in damp environments.

Symptoms

Common symptoms

• Itching in the ear canal
• Ear pain, especially when you pull on your earlobe or chew
• A feeling of fullness or blockage in the ear
• Clear or yellow discharge from the ear
• Redness and swelling of the outer ear

Symptoms in children

• Fussiness or irritability
• Tugging or pulling at the ear
• Crying when the ear is touched
• Mild fever

Symptoms in older adults

• Less severe pain, but more discharge
• Hearing loss that develops gradually
• Itching that may be more bothersome

Causes

Main causes

• Bacteria (most common) or fungi that grow in a moist ear canal
• Water staying in the ear after swimming, bathing, or showering
• Damage to the delicate skin of the ear canal from inserting cotton swabs, fingers, or other objects

Risk factors

• Swimming often, especially in lakes or pools
• Living in a hot, humid climate
• Using cotton swabs or earbuds to clean your ears
• Having a skin condition like eczema or psoriasis
• Wearing hearing aids or earplugs that trap moisture

When to see a doctor

See a doctor urgently if:

• You have severe ear pain or pain that spreads to your neck or face
• You have discharge from your ear that is thick, bloody, or smells bad
• You have fever, chills, or feel very sick
• You have swelling that closes your ear canal

Book a routine appointment if:

• You have mild ear pain or itching that lasts more than a day
• You have discharge from your ear that is not going away
• You have hearing loss or a feeling of fullness in your ear

Diagnosis

A doctor or nurse will ask about your symptoms and look inside your ear with a tool called an otoscope. This lets them see the ear canal and eardrum to check for redness, swelling, or discharge.

Tests that may be done

• In most cases, no tests are needed. If the infection is severe or does not get better, a doctor may take a swab of the discharge to find out which bacteria or fungus is causing it.

What to expect at your appointment

The exam is quick and usually not painful. The doctor may gently pull on your ear or press on the tragus (the small bump in front of your ear) to check for pain. They will also look at your eardrum to make sure it is not infected.

Treatment

Treatment focuses on clearing the infection, reducing pain and swelling, and keeping the ear dry. Most people get ear drops that contain medicine to fight bacteria or fungus and to reduce swelling. Sometimes a doctor may also prescribe pain relief medication.

Self-care at home

• Keep your ear dry: avoid swimming, showering without a shower cap, or getting water in the ear. Use a cotton ball coated with petroleum jelly to block the ear while bathing.
• Do not put anything in your ear, including cotton swabs, fingers, or earbuds.
• Over-the-counter pain relievers like paracetamol (acetaminophen) or ibuprofen can help with pain — ask your pharmacist for advice.
• Use a warm compress (a clean cloth soaked in warm water) against your ear for a few minutes to ease discomfort.

Medical treatments

A doctor will usually prescribe medicated ear drops that you use several times a day for about a week. The drops may contain an antibiotic (to kill bacteria) or an antifungal (to kill fungus), often combined with a steroid to reduce swelling. For severe or widespread infections, the doctor may also prescribe oral medicine (pills). It is important to finish the full course of treatment even if you start feeling better.

When is surgery considered?

Surgery is rarely needed. It may be considered if an abscess (a pocket of pus) forms in the ear canal and needs to be drained, or if the ear canal is too swollen for ear drops to get in. In very serious cases, a doctor might place a small wick in the ear to help deliver the medicine.

Living with this condition

While you have an infection, the most important thing is to keep your ear dry and avoid anything that might irritate it. Follow your doctor’s instructions for ear drops. The pain usually improves within a few days, and the infection clears up within one to two weeks.

Lifestyle tips

• Use earplugs or a swim cap when swimming to prevent water from entering your ears.
• After swimming or showering, tilt your head to let water drain out and gently dry the outer ear with a towel.
• Never use cotton swabs or sharp objects to clean your ears — they can damage the skin and make infections more likely.

Diet and exercise

There are no strict diet or exercise restrictions with otitis externa. You can continue your normal activities as long as you keep your ear dry. Avoid vigorous exercise if it makes your ear hurt.

Mental health and emotional wellbeing

Ear pain can be very uncomfortable and may affect your sleep or mood. It’s normal to feel frustrated or anxious while you wait for treatment. If the pain is severe or lasts a long time, talk to your doctor — they can help you manage it.

Prevention

Yes, you can reduce your risk by keeping your ears dry and avoiding inserting objects into your ears. After swimming or showering, tilt your head to each side to let water run out, then dry your outer ears with a towel. If you swim often, consider using swim plugs or a cap.

Complications

If left untreated

• Infection can spread to the surrounding skin and deeper tissues, causing cellulitis (a skin infection that may need antibiotics by mouth or through a vein).
• You may develop chronic otitis externa — a long-lasting infection that is harder to treat.
• Rarely, the infection can spread to the skull bone (malignant otitis externa) — this is a serious condition that usually affects older adults or people with weak immune systems.

Long-term outlook

With proper treatment, most people with otitis externa recover fully within a week or two. Even if your symptoms are severe, medical care can usually clear the infection and prevent complications. Following prevention tips can help you avoid future episodes.

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