Otitis externa patient overview

Overview

Otitis externa is an infection or inflammation of the outer ear canal, the tube that leads from the outside of your ear to your eardrum. It's often called 'swimmer's ear' because it can happen after water stays in the ear. The condition causes pain, itching, and sometimes discharge from the ear.

Yes, otitis externa is a common condition, especially in people who swim frequently or live in humid climates. It affects millions of people each year worldwide.

Otitis externa can affect people of all ages, but it is most common in children and young adults. People who swim a lot, use hearing aids, have eczema, or have narrow ear canals are at higher risk.

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
• Mild hearing loss or muffled hearing
• Clear, yellow, or bloody discharge from the ear
• Redness and swelling around the ear opening

Symptoms in children

• Tugging or pulling at the ear
• Fussiness or crying when the ear is touched
• Trouble hearing or seeming distracted
• Fever in some cases

Symptoms in older adults

• Symptoms may be less obvious initially
• Increased risk of complications such as malignant otitis externa, especially in people with diabetes or weakened immune systems
• Severe pain or discharge that doesn't improve

Causes

Main causes

• Bacteria (most often Pseudomonas aeruginosa or Staphylococcus aureus)
• Fungi (less common, often in people with chronic ear problems)
• Moisture in the ear canal (from swimming, bathing, or humidity)
• Trauma to the ear canal (from cotton swabs, fingernails, or hearing aids)
• Allergic reactions to hair products, earrings, or earbuds

Risk factors

• Swimming, especially in lakes or pools with poor hygiene
• Living in a hot, humid climate
• Using cotton swabs, earbuds, or other objects to clean the ear
• Wearing hearing aids, earplugs, or headphones for long periods
• Having a skin condition like eczema, psoriasis, or seborrheic dermatitis
• Narrow ear canals (from birth or injury)
• Excessive earwax buildup

When to see a doctor

See a doctor urgently if:

• Severe ear pain that does not respond to simple pain relief
• Fever over 38°C (100.4°F) with ear pain
• Swelling around the ear or the side of the face
• Hearing loss that is getting worse
• Symptoms in someone with diabetes or a weakened immune system

Book a routine appointment if:

• Mild ear pain or itching that lasts more than a few days
• Discharge from the ear that is not improving
• Feeling of fullness in the ear that doesn't go away after swimming

Diagnosis

Your doctor will ask about your symptoms and examine your ear using a lighted instrument called an otoscope. They will look for redness, swelling, discharge, or narrowing of the ear canal. The doctor may gently move your earlobe to see if that causes pain, which is a common sign of otitis externa.

Tests that may be done

• Otoscopic examination (looking inside the ear)
• A swab of the ear discharge to identify the bacteria or fungus (if symptoms are severe or not responding to treatment)
• Hearing test (audiometry) if hearing loss is a concern

What to expect at your appointment

The examination is quick and usually painless. You may feel some discomfort when the doctor moves your earlobe or inserts the otoscope. If a swab is needed, it's a gentle process. Based on the findings, your doctor will explain the condition and discuss treatment options. You should feel comfortable asking questions about your care.

Treatment

Treatment for otitis externa focuses on clearing the infection, reducing pain and swelling, and keeping the ear clean and dry. Most cases can be managed at home with self-care and medication. Your doctor may prescribe ear drops or oral medicine. It's important to follow the treatment plan and avoid getting water in your ear until it heals.

Self-care at home

• Keep the ear dry: use a shower cap or earplugs while showering or bathing
• Avoid swimming until the infection has completely cleared
• Do not insert anything into your ear, including cotton swabs, fingers, or objects
• Use a warm, dry cloth or gentle heat pack on the outside of the ear to help with pain
• Take simple pain relievers like paracetamol or ibuprofen (check with your doctor or pharmacist first)

Medical treatments

Your doctor will likely prescribe ear drops that contain antibiotics and sometimes a mild steroid to reduce swelling. The drops are usually used several times a day for a week or more. If the ear canal is very swollen, the doctor may need to place a wick (a small piece of cotton) to help the drops reach the infection. In some cases, especially if the infection is severe or caused by a fungus, your doctor may prescribe oral medication. All treatments should be used exactly as directed. Do not use ear drops if you have a perforated eardrum unless specifically prescribed by a doctor.

When is surgery considered?

Surgery is rarely needed for otitis externa. It may be considered if a complication develops, such as an abscess that needs draining, or if there is a narrow ear canal that requires widening. Most people recover without surgery.

Living with this condition

While recovering from otitis externa, you may need to avoid getting water in your ear for about one to two weeks. Use a cotton ball coated with petroleum jelly (Vaseline) to plug the ear when showering. Avoid wearing hearing aids or earplugs until the infection clears. You may notice some hearing loss during the infection, but this usually improves after treatment.

Lifestyle tips

• Keep ears dry – dry them gently with a towel after bathing
• Do not use cotton swabs or other objects to clean inside your ears
• If you swim, use well-fitting earplugs or a swim cap
• If you use hearing aids, remove them at night to let the ear canal dry out

Diet and exercise

No specific diet is needed, but eating a balanced diet can help your immune system. You can exercise as normal, but avoid activities that get water in your ear, such as swimming or even vigorous workouts that cause sweating into the ear. If you sweat a lot during exercise, dry your ears afterward.

Mental health and emotional wellbeing

Ongoing ear pain and hearing loss can be frustrating and may cause stress or anxiety, especially if symptoms last for several weeks. You might feel isolated if you cannot swim or socialize as usual. It's important to talk to your doctor about any emotional concerns. Simple relaxation techniques, like deep breathing or listening to music, can help you cope.

Prevention

You can reduce your risk of otitis externa by keeping your ears dry, avoiding inserting objects into the ear canal, and treating any underlying skin conditions like eczema. After swimming or showering, tilt your head to let excess water drain out, and gently dry the outside of the ear with a towel.

Complications

If left untreated

• The infection can spread to nearby tissues, causing cellulitis (infection of the skin) or abscess formation
• Chronic otitis externa – long-term or recurring infection that is harder to treat
• Malignant (necrotizing) otitis externa – a rare but serious infection that spreads to the bones at the base of the skull, most often in people with diabetes or weakened immune systems
• Temporary hearing loss that may become permanent if the ear canal is damaged

Long-term outlook

With proper treatment, most people with otitis externa feel better within a few days and are completely healed within one to two weeks. Even in severe cases, timely medical care leads to good outcomes. Following your treatment plan and taking steps to prevent future infections greatly reduces the chance of complications.

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