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Outer ear infection (otitis externa)

Published by Bupa's health information team, August 2008.

This factsheet is for people who have otitis externa, or who would like information about it.

Otitis externa is an inflammation of the skin in the external ear canal (the tube that leads into your ear). It is often caused by an infection.

About otitis externa

Illustration of the ear, showing the location of the ear canal
The ear, showing the location of the ear canal

Unlike middle ear infection (otitis media), otitis externa is a problem that commonly affects adults, although children can get it as well. It's sometimes called swimmer's ear as it often develops after you have spent a long time in water.

There are three types of otitis externa.

  • Acute otitis externa comes on suddenly and goes away within a few weeks.
  • Chronic otitis externa lasts for several weeks and can keep coming back over a period of three months or more.
  • Localised otitis externa happens when a hair follicle at the entrance to your ear canal becomes infected, causing a boil.

Symptoms of otitis externa

Symptoms of otitis externa can include:

  • itching
  • discharge from the ear
  • temporarily dulled hearing
  • pain - this can be severe if your otitis externa is caused by a boil

If you have any of these symptoms, you should see your GP. This is particularly important if you have problems with your immune system, are diabetic or have severe ear pain or discharge.

Complications of otitis externa

Otitis externa can sometimes progress to a severe infection, called malignant otitis. However, this condition is rare, and is most likely to occur in people who have problems with their immune system (for example, people who have diabetes or HIV/AIDS, or those who have had chemotherapy for cancer).

In malignant otitis, the infection spreads into the bones surrounding the ear, which make up the skull. It can be life-threatening without the necessary treatment.

Causes of otitis externa

Otitis externa is usually caused by a bacterial infection. It can also sometimes be caused by a fungal or yeast infection. Anything that irritates the skin of your ear or causes an allergic reaction can also cause otitis externa.

You are more likely to develop otitis externa if you:

  • swim in contaminated water/swimming pools that aren't very well maintained - this allows bacteria to get into your ear
  • live in a hot, humid climate (this means you may get more perspiration in your ear canal - and bacteria thrive in moist environments)
  • have a narrow ear canal
  • have a skin condition, such as dermatitis or psoriasis, which can cause your skin to become inflamed and at greater risk from getting infected
  • are sensitive to certain soaps, shampoos or hairsprays - these products can irritate the skin in your ear, causing inflammation and greater risk of infection
  • use hearing aids or earplugs, which may irritate the skin in your ear
  • damage the skin in your ear with a cotton bud, your fingernail, or any other object

Diagnosis of otitis externa

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP will look into your ear using an instrument called an otoscope to check for signs of inflammation and infection. He or she will also check to see whether you feel pain when the outside of your ear or your jaw is moved.

If you have otitis externa that hasn't cleared after treatment with antibiotic drops, your GP may take a sample of the discharge from your ear using a swab. This will be sent to a laboratory for testing.

Your GP may be able to give you any treatment you need, or he or she may need to refer you to an ear, nose and throat (ENT) consultant - a doctor specialising in conditions affecting the ear.

Treatment of otitis externa

If you have any discharge in your ear, your doctor or nurse will gently remove it by wiping your ear with a cotton-covered instrument. Any debris in the ear may also be suctioned out. This is normally done by an ENT consultant in hospital.

Medicines

You may be prescribed one of the following treatments for otitis externa:

  • aluminium acetate ear drops - these help to reduce the inflammation in your ear
  • acetic acid ear drops - acetic acid is an antiseptic and is effective at getting rid of some types of bacteria - it may be used if you have mild otitis externa
  • ear drops containing an antibiotic or antifungal, to get rid of your infection - these are often given in combination with a steroid to reduce the itching and inflammation
  • antibiotic pills, if you have a severe infection, the infection has spread outside of your ear, or your GP thinks you are at risk of getting a severe infection
  • a painkiller, such as paracetamol or ibuprofen, if you are in a lot of pain

It may be difficult to get ear drops into your ear if your ear is very swollen, so your doctor or nurse may apply the treatment using an ear wick or a gauze dressing. An ear wick is a cotton pad, which is placed in your ear and absorbs the drops when they are applied. This allows the ear drops to stay in constant contact with the affected part of your ear. The ear wick will usually be left in place for at least a couple of days, before being removed by your doctor or nurse.

An ear dressing is a small length of very narrow gauze bandage, which your nurse or doctor will smear with antibiotic ointment and gently place in your ear using a light and small forceps. You may be shown how to remove the dressing yourself.

Prevention of otitis externa

If you have had otitis externa, the best thing you can do is understand how you got the infection and learn how to avoid getting it again.

If you tend to have problems with your ears, one of the most important things you can do is to keep your ears dry. You can do this by:

  • making sure you don't lie with your head underwater in the bath
  • putting cotton wool smeared with petroleum jelly (Vaseline) in your ears before you wash your hair or have a shower
  • wearing silicone ear plugs if you go swimming - or avoiding swimming altogether
  • drying your ear with a hair dryer (on the lowest heat setting) after washing your hair

Other tips to prevent otitis externa include:

  • don't use cotton buds or other objects to clean your ear canal
  • if you regularly use ear plugs (eg for safety equipment at work), make sure you use a clean pair every day
  • keep away from sub-standard swimming pools and contaminated water
  • wash your hands before touching your ears
  • if you have had otitis externa in the past - avoid anything that you know may trigger it, such as hairsprays or shampoos

Further information

 

Related topics

Sources

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Sebastian Hendricks, MSc, Consultant in Audiovestibular Medicine, Barnet & Chase Farm Hospitals NHS Trust, Edgware Community Hospital, and by Bupa doctors. It has also been reviewed by Deafness Research UK. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: August 2008.

 

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