Otitis externa in teenagers

Overview

Otitis externa, often called swimmer's ear, is an infection of the outer ear canal – the tube that leads from the outside of your ear to your eardrum. It causes pain, swelling, and sometimes discharge.

Yes, otitis externa is common, particularly in teenagers who spend time in the water or use earphones often.

It most often affects teenagers, especially those who swim frequently, have narrow ear canals, or use cotton swabs in their ears.

Symptoms

Common symptoms

• Pain in the ear that gets worse when you pull on your earlobe or chew
• Itching inside the ear
• A feeling of fullness or blockage in the ear
• Redness and swelling of the outer ear
• Clear, yellow, or bloody fluid draining from the ear
• Muffled hearing or temporary hearing loss

Symptoms in children

• Children may have the same symptoms, but they might not be able to describe their pain well – look for fussiness, tugging at the ear, or changes in sleep or appetite.

Symptoms in older adults

• In older adults, symptoms are similar, but the risk of complications (like the infection spreading) can be higher due to weaker immune systems or other health conditions.

Causes

Main causes

• Bacteria or fungi growing in the moist, warm ear canal – often after swimming or bathing
• Scratching or injuring the ear canal (for example, with cotton swabs, fingernails, or earplugs)
• Allergic reactions to hair products, earrings, or hearing aid materials

Risk factors

• Swimming in lakes, pools, or the sea – water gets trapped in your ear
• Using cotton swabs or other objects to clean your ears
• Wearing earphones or hearing aids for long periods
• Having a skin condition like eczema or psoriasis in or around the ear
• Narrow ear canals (some people are born with them)

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above

Book a routine appointment if:

• If your ear feels painful, itchy, or blocked for more than two days
• If you notice any discharge or hearing changes
• If you have diabetes or a weakened immune system and think you might have an ear infection

Diagnosis

A doctor can usually tell if you have otitis externa by looking inside your ear with a special tool called an otoscope. This shows them if the ear canal is red, swollen, or has debris.

Tests that may be done

• Most people don’t need any tests
• If the infection does not clear up, the doctor might take a sample of the discharge and send it to a lab to find out exactly what germ is causing it

What to expect at your appointment

The exam is quick and painless, though it might be a little uncomfortable if your ear is sore. The doctor will gently pull your earlobe to see if that makes the pain worse – that is a common sign of otitis externa.

Treatment

Treatment focuses on clearing the infection and keeping the ear dry so it can heal. Most people get better with ear drops prescribed by a doctor, plus simple self-care at home.

Self-care at home

• Keep your ear dry – use a shower cap or a cotton ball coated with petroleum jelly in the outer ear when you bathe
• Avoid swimming until the infection has gone
• Do not put anything in your ear (no cotton swabs, fingers, or earplugs)
• Use a hair dryer on the lowest heat setting, held a few inches from your ear, to help dry any moisture
• Take over-the-counter pain relievers like paracetamol or ibuprofen if the pain bothers you – follow the directions on the pack
• Rest your ear – avoid wearing earphones or hearing aids until it heals

Medical treatments

Your doctor will usually prescribe ear drops that contain an antibiotic or antifungal medicine to fight the infection. Sometimes they also include a steroid to reduce swelling and pain. You’ll need to use the drops exactly as directed, even if you start feeling better. If the infection is severe, your doctor may also prescribe oral antibiotics or pain medication. Always follow your doctor’s instructions and finish the full course of treatment.

When is surgery considered?

Surgery is rarely needed for otitis externa. It may be considered if the infection spreads to the surrounding bone or tissue, or if there is a collection of pus that needs to be drained. This is very uncommon.

Living with this condition

While you have an infection, you may need to avoid swimming and keep your ears dry. That can be frustrating, but it helps the infection clear faster. You can still bathe carefully. Most people feel better within a few days, but it's important to finish all the treatment your doctor gives you.

Lifestyle tips

• Avoid using cotton swabs or anything else to clean your ears – your ears clean themselves
• After swimming or showering, tilt your head and let water drain out, then dry the outer ear gently with a towel
• If you use earphones or earbuds, take breaks every hour to let your ears air out
• If you are a swimmer, consider wearing swim plugs or a swim cap to keep water out of your ears in the future

Diet and exercise

No special diet is needed for otitis externa. Eating a healthy, balanced diet supports your immune system, which can help you heal. Exercise is fine as long as you keep your ears dry – avoid swimming or heavy sweating until the infection has resolved.

Mental health and emotional wellbeing

Ear pain can be annoying and affect your sleep or concentration. If you feel frustrated or worried, that’s normal. Remember that this infection usually goes away quickly with treatment. Talk to a parent, teacher, or school nurse if you need support. If you ever feel overwhelmed or unable to cope, reach out to a trusted adult or a mental health support line.

Prevention

Yes, you can reduce your risk of otitis externa with a few simple habits. Keep your ears dry, avoid inserting objects into your ear canal, and be careful with earphones. After swimming or showering, dry your ears gently.

Complications

If left untreated

• The infection can spread to the outer ear (making it very swollen and red)
• It can cause chronic (long-lasting) infection in the ear canal
• In rare cases, it can spread to nearby bone or tissue, leading to a more serious condition called malignant otitis externa

Long-term outlook

With proper treatment, most cases of otitis externa clear up completely within one to two weeks. Even if it takes a bit longer, the outlook is very good. Following your doctor’s advice and keeping your ears dry will help you heal and prevent it from coming back.

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