Otitis externa is an inflammation of the ear canal. The inflammation may be caused by infection, allergy or other causes. Treatment with ear drops is usually effective. Further episodes of the condition returning (recurrences) can often be prevented by the tips given below.
This leaflet is part of our series on ear infection
What is otitis externa?
Otitis means inflammation of the ear. The inflammation is usually due to an infection. Otitis externa means that the inflammation is confined to the ear canal and does not go further than the eardrum. There is a separate leaflet called Ear Infection (Otitis Media), which is an infection of the middle ear. There is also a separate leaflet called Chronic (Persistent) Otitis Externa which deals with otitis externa which has not got better within three months.
What causes otitis externa?
Otitis externa is an infection of the skin of the ear canal and is very common. It often occurs 'out of the blue' for no apparent reason.
In general, the infections are caused by a germ (bacterium). Occasionally, they can be due to a fungal or yeast infection.
Some people are more prone to otitis externa. If you get water, shampoo, soap, hairspray, etc, in an ear then it may cause it to itch. You may then scratch or poke the ear. This can damage the skin in the ear canal and cause inflammation. Inflamed skin can quickly become infected. A vicious circle may then develop. The inflammation and infection cause more itch, you then scratch more, which then can makes things worse.
Other possible causes of otitis externa
- Swimming. Otitis externa is five times more common in regular swimmers compared with non-swimmers. It is due to the water which gets into the ear canal. In fact, otitis externa is sometimes called swimmer's ear.
- Weather. Otitis externa is more likely to develop in hot, humid and 'sweaty' weather. It is more common in hot countries.
- Skin problems. Eczema or psoriasis may affect the ear canal and cause an otitis externa.
- Ear syringing to clear earwax. This may irritate the ear canal and cause inflammation.
- Middle ear infections. Sometimes middle ear infections (otitis media) can produce some discharge for some time which can then cause otitis externa.
What are the symptoms of otitis externa?
The symptoms of otitis externa can vary between cases. Common symptoms include itch, ear discharge, temporary dulled hearing, and pain. Your ear may feel blocked or full. One or both ears can be affected.
Sometimes the glands in your neck or around your ear can become enlarged and sore.
Although it is more common for only one ear to be affected, in some cases both ears become infected.
What is the treatment for otitis externa?
Most people with otitis externa are given treatment without having any tests, as the diagnosis is usually clear from examination of your ear. If you recognise the condition yourself you could try some eardrops for otitis externa, available without prescription, such as those containing 2% acetic acid (EarCalm®).
However, your doctor or nurse may decide to take a specimen of the discharge (a swab) to find out which germ is causing the infection. This helps to guide the choice of antibiotic ear drops to use. (Some germs are resistant to some types of antibiotic.)
Ear drops or sprays
A doctor or nurse will usually prescribe a short course of ear drops or an ear spray. These usually contain an antibiotic such as clioquinol or neomycin to clear any infection and a steroid to reduce the inflammation and itch. A combination of clioquinol and flumetasone is often used. It may take a week or so of treatment for symptoms to go completely. There are several brands of drops or sprays used to treat otitis externa. If one does not work well then a doctor or nurse may advise changing to another brand with different ingredients. A commonly used spray contains dexamethasone, neomycin and acetic acid (Otomize Spray®).
When you use ear drops:
- Lie with the affected ear upwards.
- Put several drops into the ear and lie in this position for 1-2 minutes.
- Press the cartilage at the front of the ear canal a few times to push the drops deep inside the ear canal.
As a rule, do not leave balls of cotton wool in the ear canal. This stops the discharge (debris) which needs to come out. However, if the discharge is heavy, you may need to place some cotton wool lightly in the outer part of the canal to mop up the discharge. If you use cotton wool, replace it frequently with a fresh piece.
You should not try to clean your ear canal with cotton buds. If you stick buds or other objects into your ear they may damage and irritate the inflamed skin, and make things worse. Just clean the outside of the ear with a cloth when any discharge appears.
Other treatment may be needed if the inflammation is more severe or if the above measures do not work within a week or so. These may include:
- A doctor or nurse may clean the ear canal. They do this by using cotton wool on the end of a special stick which is gently pushed inside the ear canal to mop up any discharge or debris. Sometimes gentle suction or syringing is used. This removes the discharge lying in the ear canal.
- Sometimes a gauze wick is soaked in ear drops and is pushed into the ear canal. This gets the drops right to the end of the ear canal, particularly if it is very swollen.
- If your infection is particularly severe or there is infection in the skin around the ear (cellulitis) then you may be given antibiotic tablets.
How can I prevent further bouts of otitis externa?
If you are prone to otitis externa, to help prevent recurrences you should keep your ears dry and leave them alone! This means:
- Try not to let soap or shampoo get into your ear canal. You can do this when you have a shower, by placing a piece of cotton wool coated in soft white paraffin (eg, Vaseline®) into the outer ear.
- Do not use corners of towels or cotton buds to dry any water that does get in the ear canal. This will push things further in. Let the ear dry naturally.
- Try not to scratch or poke the ear canal with fingers, cotton wool buds, towels, etc.
- Do not clean the ear canal with cotton buds. They may scratch and irritate and push wax or dirt further into the ear. The ear cleans itself and bits of wax will fall out now and then.
- When you swim try to keep your ears dry. You can do this by wearing a tightly fitting cap that covers the ears. Some swimmers use silicone rubber earplugs but only use them if they do not irritate the skin in your ear canal.
Dr Tim Kenny
Dr Laurence Knott
Dr Helen Huins