Otitis externa in older adults

Overview

Otitis externa, also called swimmer's ear, is an infection of the outer ear canal, the tube that leads from the outside of the ear to the eardrum. In older adults, it often happens because the skin in the ear canal becomes dry or damaged, making it easier for germs to grow.

Yes, otitis externa is a common condition, particularly in warm, humid climates or after swimming. In older adults, it may be more frequent due to changes in the skin of the ear canal and a weaker immune system.

Anyone can get otitis externa, but older adults are at higher risk. This includes people who use hearing aids, have diabetes, eczema, or a weakened immune system, or who often clean their ears with cotton swabs or other objects.

Symptoms

Common symptoms

• Ear pain that gets worse when you pull on the outer ear or chew
• Itching inside the ear
• A feeling of fullness or blockage in the ear
• Watery or pus-filled discharge from the ear
• Muffled hearing

Symptoms in older adults

• Pain may be less obvious; instead, an older adult might seem confused or dizzy
• Discharge from the ear that may be thick or bloody
• Trouble hearing clearly
• Fever or feeling generally unwell can signal a more serious infection

Causes

Main causes

• Bacteria or fungi that grow in the ear canal when it stays moist
• Damage to the thin skin of the ear canal from scratching, using cotton swabs, or cleaning too forcefully
• Trapping water in the ear after swimming or bathing

Risk factors

• Swimming or getting water in the ears often
• Using hearing aids, earplugs, or headphones for long periods
• Having skin conditions like eczema or psoriasis
• Having diabetes or a weakened immune system
• Cleaning ears with cotton swabs, bobby pins, or other objects

When to see a doctor

See a doctor urgently if:

• If you have severe ear pain, fever, or swelling around the ear
• If you are diabetic and have any ear symptoms, as infection can spread quickly
• If you have trouble moving your face or hearing suddenly gets worse

Book a routine appointment if:

• If ear pain or itching lasts more than a couple of days
• If you notice discharge from your ear
• If you feel like your ear is blocked or your hearing is not normal

Diagnosis

A doctor will ask about your symptoms and look into your ear using a handheld instrument called an otoscope. This lets them see the ear canal and eardrum. They may gently pull on your ear to check for pain.

Tests that may be done

• Sometimes the doctor will take a small sample of fluid from your ear with a cotton swab. This is sent to a lab to find out which germ is causing the infection.
• If you have diabetes or a severe infection, the doctor might order a CT scan or MRI to check if the infection has spread to the bone.

What to expect at your appointment

The exam is usually quick and not painful. If your ear canal is very swollen, the doctor might put a small sponge wick into the ear to help medicine reach the infection. You will be given instructions on how to use ear drops at home.

Treatment

Treatment aims to clear the infection and reduce pain. Most people can be treated with medicated ear drops. Self-care at home is also important to help the ear heal.

Self-care at home

• Keep your ear dry while it heals. Use a shower cap or put a cotton ball coated with petroleum jelly in your outer ear when showering.
• Do not put anything into your ear, including cotton swabs, fingers, or eardrops that are not prescribed.
• Apply a warm compress (a clean cloth soaked in warm water and wrung out) to the outside of your ear to ease discomfort.

Medical treatments

Doctors usually prescribe medicated ear drops that contain antibiotics to fight bacteria or antifungals to fight yeast. Sometimes the drops also include a steroid to reduce swelling and pain. If your ear canal is very swollen, a thin sponge wick may be placed inside for the drops to soak into. You will be told to use the drops for a specific number of days, even if you feel better. Over-the-counter pain relievers like acetaminophen or ibuprofen can help with pain, but always check with your doctor or pharmacist first.

When is surgery considered?

Surgery is rarely needed. It may be considered if the infection spreads to the bones of the skull (a condition called malignant otitis externa) and does not respond to medicines. In that case, a specialist may need to clean out infected tissue.

Living with this condition

During treatment, avoid getting water in your ear. When you shower, use a shower cap or a cotton ball with petroleum jelly. If you use a hearing aid, keep the battery compartment open and let it dry out. You may need to stop wearing it for a few days if your ear is painful.

Lifestyle tips

• After swimming or bathing, tilt your head to let water drain out and dry the outer ear with a towel.
• Avoid inserting any objects into your ear, even for cleaning.
• If you have diabetes, keep your blood sugar well controlled to help prevent infections.

Diet and exercise

Eating a balanced diet and staying active can help your immune system fight infection. There is no specific diet for otitis externa, but staying hydrated and getting enough rest supports healing.

Mental health and emotional wellbeing

Ear pain and temporary hearing loss can be frustrating and may make you feel isolated. It is normal to feel anxious or low. Talk to your family or a healthcare provider about how you are feeling. Most people recover fully, and hearing returns once the infection clears.

Prevention

You can lower your risk by keeping your ears dry and clean. After swimming or showering, dry the ears gently with a towel. You can also use a few drops of a mixture of white vinegar and rubbing alcohol (equal parts) after swimming to help prevent infection, but check with your doctor first, especially if you have a hole in your eardrum.

Vaccines

There is no vaccine that specifically prevents otitis externa.

Screening programmes

There is no routine screening for otitis externa. If you have risk factors like diabetes or use hearing aids, it is a good idea to check your ears regularly for any early signs of infection.

Complications

If left untreated

• The infection can become chronic, causing ongoing pain and discharge.
• The ear canal may narrow, leading to persistent hearing loss.
• In severe cases, the infection can spread to the bones of the skull (malignant otitis externa), which can damage nerves and cause facial paralysis.
• If the infection spreads to the brain, it can be life-threatening.

Long-term outlook

With prompt treatment, otitis externa almost always gets better without lasting problems. Most people recover fully in about a week. Even severe cases can be treated successfully, especially if caught early. Following your doctor’s advice and taking good care of your ears will help ensure a good outcome.

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