Otitis externa in adults

Overview

Otitis externa, also called swimmer's ear, is an infection or inflammation of the outer ear canal, the tube that connects the outside of your ear to your eardrum.

Yes, otitis externa is a common condition, especially in people who swim or live in warm, humid climates.

It can affect adults of any age, but is more common in those who swim regularly, use hearing aids or earplugs, or have skin conditions like eczema.

Symptoms

Common symptoms

• Ear pain that worsens when you pull on your earlobe
• Itching inside the ear canal
• Discharge from the ear that may be clear, yellow, or pus-like
• A feeling of fullness or blockage in the ear
• Muffled hearing or temporary hearing loss

Symptoms in children

• Children may cry more, tug at their ear, or have trouble sleeping
• They may complain of ear pain or itchiness
• Fever can sometimes occur

Symptoms in older adults

• Pain may be less noticeable, but the ear can still feel blocked
• Discharge may be thicker or more noticeable
• Hearing loss can be more pronounced due to age-related changes

Causes

Main causes

• Infection by bacteria (most common) or fungi
• Moisture trapped in the ear canal, for example after swimming or bathing
• Scratching or injuring the ear canal, such as with cotton swabs or fingernails

Risk factors

• Swimming or spending time in water
• Using hearing aids, earplugs, or headphones that trap moisture
• Having a skin condition like eczema or psoriasis
• A narrow ear canal that retains water
• Excessive ear cleaning or using objects to scratch the ear

When to see a doctor

See a doctor urgently if:

• If you have severe ear pain or a high fever
• If you notice redness or swelling spreading to your face or neck
• If you have hearing loss that comes on suddenly

Book a routine appointment if:

• If you have mild ear pain or itching that lasts more than a few days
• If you notice discharge from your ear for the first time
• If you have a history of ear problems and symptoms return

Diagnosis

A doctor or nurse will ask about your symptoms and look inside your ear using a handheld tool called an otoscope.

Tests that may be done

• A swab of any discharge may be taken to identify the bacteria or fungus causing the infection
• Hearing tests may be done if hearing loss is present

What to expect at your appointment

The examination is quick and usually painless. The doctor will check the ear canal for redness, swelling, and discharge, and may gently remove any debris.

Treatment

Treatment focuses on clearing the infection, reducing pain, and keeping the ear dry. Most cases are managed at home or with simple medical care.

Self-care at home

• Keep your ear dry while showering by using a shower cap or a cotton ball coated with petroleum jelly
• Avoid swimming or getting water in your ear until the infection clears
• Do not insert anything into your ear, including cotton swabs or fingers
• Take over-the-counter pain relievers for discomfort, following the package instructions

Medical treatments

A healthcare provider may prescribe ear drops that contain medication to fight bacteria or fungi and reduce inflammation. In some cases, a small wick may be placed in the ear canal to help the drops reach the infection if swelling is severe. Oral medications are sometimes needed for more serious infections.

When is surgery considered?

Surgery is rarely needed for otitis externa. It may be considered if an abscess forms behind the ear or if the infection spreads to nearby tissues and does not respond to other treatments.

Living with this condition

During an infection, avoid getting water in your ear and try not to touch or scratch it. Most people can return to normal activities soon after treatment begins.

Lifestyle tips

• Use earplugs designed for swimming or showering to protect your ears
• Dry your ears gently with a towel after bathing
• Avoid using objects to clean your ears

Diet and exercise

No special diet is needed. You can exercise as usual as long as you keep your ear dry and avoid activities that put pressure on the ear.

Mental health and emotional wellbeing

Persistent ear pain or hearing loss can be frustrating and affect your mood. If you feel anxious or sad about your symptoms, talk to your doctor or a mental health professional.

Prevention

Yes, you can reduce your risk by keeping your ears dry, avoiding inserting objects into the ear canal, and treating skin conditions like eczema promptly.

Complications

If left untreated

• Chronic otitis externa, which can cause long-term itching and discharge
• Temporary hearing loss that may become permanent if the infection damages the ear canal or eardrum
• Spread of infection to the skin around the ear (cellulitis) or to the bone at the base of the skull (malignant otitis externa, a rare but serious condition)

Long-term outlook

With prompt and proper care, almost all cases of otitis externa heal completely without lasting problems. Even if complications occur, they can usually be treated effectively.

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