Outer ear infection or inflammation

Also known as otitis externa or swimmer's ear

An outer ear infection affects the outer opening of the ear and the tube that runs from the outer ear to the middle ear (the ear canal). It causes pain, itchiness and swelling. These symptoms can also be due to inflammation caused by an allergy or irritation.

Key points

  1. Outer ear infection or inflammation is also known as otitis externa or swimmer's ear. It is different to otitis media, which affects your middle ear
  2. It is often seen in swimmers or people whose ears are wet a lot of the time. Other causes include damage from cleaning, using earbuds or hearing aids, chemical irritation and infected hair follicles.
  3. People of all ages can be affected, but it most often occurs in adults aged 45–75 years.
  4. Treatment options include keeping the infected ear dry and using ear drops.

What causes outer ear pain and swelling?

The most common cause of outer ear inflammation is an infection caused by bacteria, or less often, fungus. Your risk of getting an infection is increased if:

  • Your ears are often wet. Dampness creates an ideal environment for bacteria and fungi to grow and make your ears more prone to infection.
  • Skin damage. This could be from scratching, cleaning with cotton buds, or using ear buds, in-ear headphones or a hearing aid.
  • Use of chemicals. These are found in products such as shampoo, conditioners, hair spray and hair dye that can irritate your ears, making them more prone to infection.
  • Skin or allergic conditions. Such as dermatitispsoriasiseczemaacneasthma or hay fever.
  • Narrow ear canals. This stops water draining away easily.
  • A health condition that affects your ability to fight infection. For example, diabetes or HIV or if you are undergoing certain treatments, such as chemotherapy.
  • Infection of a hair follicle in your ear canal. This can cause a pimple or boil.
  • Discharge from middle ear infections. Sometimes infections of the inner ear can produce a pussy discharge that gets stuck in the ear canal and this can cause an outer ear infection.

What are the symptoms of outer ear infection?

Often only one ear is affected. Symptoms affect your ear and surrounding area, including:

  • ear pain or pain when moving your ear or jaw
  • itchiness and irritation in or around the ear canal
  • swelling and redness of the ear canal and surrounding area
  • peeling skin inside and around the outside ear
  • fluid from your ear, often with a bad smell
  • hearing loss.

A very rare but dangerous complication is malignant otitis externa. This is the spread of infection to the bones of your ear canal and lower part of your skull. If you have an outer ear infection and experience strange symptoms, such as dizziness or muscular weakness in your face, seek immediate medical help.

How is an outer ear infection diagnosed?

Your doctor will ask you about your symptoms and examine your ear. If your symptoms keep returning, then a swab (using a sterile cotton wool bud) from your ear will be taken and sent to the laboratory for testing.

What is the treatment for outer ear pain and swelling?

Initially, your doctor will clean the affected ear and prescribe ear drops and recommend you follow simple self-care measures. Further treatment depends on the severity and cause of the infection or inflammation. For example, specific treatments for skin conditions such as dermatitis, psoriasis or eczema may be prescribed. 

Self-care

  • Try to keep the affected ear dry.
    • Wear a shower cap while showering and avoid swimming until symptoms have fully cleared.
    • If water gets into your ears, turn your head to the side and pull your earlobe in different directions to help the water drain out.
  • Gently clean any discharge from the outer ear with cotton wool. Do not insert cotton buds in your ear.
  • Remove anything from the ear that may cause irritation, such as earrings or hearing aids.
  • Take pain relief such as paracetamol or ibuprofen if necessary and according to medical advice.
  • If a boil is the cause, holding a warm cloth over the affected ear can provide relief.

Ear candles do not help outer ear infection and are not recommended for treatment as they may cause more injury to the ears.

Ear drops

Outer ear infection can get better without ear drops, but this may take weeks. Ear drops can help speed up the healing process. Ear drops usually need to be used several times a day for about a week.

For the treatment of mild discomfort of your outer ear, usually caused by water in the ear, you can get ear drops from your pharmacy, such as Vosol®. Other ear drops need to be prescribed by a doctor, such as:

  • eardrops that contain antibiotics to treat infection, for example, Soframycin®
  • antibiotic eardrops combined with a steroid to reduce the inflammation (swelling) associated with the ear infection, for example, Ciproxin HC®, Sofradex®, Locacorten-Vioform®and Kenacomb®.  

 

Read more about eardrops.

Return to the doctor or nurse if things don't settle. If problems with outer ear infection or inflammation are ongoing, your doctor may refer you to an audiologist or an ear specialist for further assessment and treatment.

How can it be prevented?

It's not always possible outer ear infection or inflammation, but there are things you can do to reduce your risk of developing the condition.

  • Dry your ears thoroughly with a towel to remove water, sweat or moisture. Use a hair dryer on low to gently dry the ear canal. Don’t use the corner of a towel.
  • Avoid damaging your ears by not putting anything inside your ear canal, including cotton wool buds.
  • If you swim regularly, use a swim cap that covers your ears or use earplugs (inserted gently to avoid damage) to help prevent water getting into your ears.
  • Give your ears a break from ear devices such as ear plugs, hearing aids and in-ear headphones.
  • Treat and prevent other conditions that may be triggering otitis externa, such as allergiesdermatitis, psoriasis and eczema.

Learn more

Otitis externa DermNet New Zealand, NZ, 2005

References

  1. Swimmer's ear Better Health Channel, Australia, 2014
  2. Otitis externa Patient Info, UK, 2016
Credits: Health Navigator Editorial Team .