Overview

Otitis externa is a condition of the outer ear, and is caused by inflammation of the skin in the ear canal (the tube between the outer ear and the eardrum). The condition is often called swimmer’s ear.

Causes of otitis externa

It can happen for no apparent reason. However, there are several likely causes.

• Getting water, shampoo or soap into the ear canal can irritate the skin.
• Damage to the skin in the ear canal (caused by cotton buds, scratching or poking) can cause inflammation and infection.
• Water can get into the ear canal while you are swimming. This is why the condition is called swimmer’s ear. The stagnant water triggers an infection.
• Hot, humid weather makes inflammation of the ear canal more likely to develop.
• Skin conditions such as eczema, or psoriasis, can make you more likely to get problems with the ear canal.
• An increased build-up of wax in the ear canal can start to cause irritation, or water can become trapped behind the wax and cause an infection.

Symptoms of otitis externa

• Itching, pain or discomfort in the ear canal and often dry, flaky skin around the outside of the ear.
• A watery discharge from the ear canal.
• The ear canal starting to close up due to swelling and inflammation.
• Reduced hearing (in severe cases).
• Discomfort moving the jaw when chewing or speaking.

Treatment for otitis externa

You may be prescribed eardrops or spray. These usually have a combination of an antibiotic to treat any infection, and a steroid to reduce the inflammation and itching. The treatment usually lasts for 7 to 10 days. You should follow the prescribed course.

You may also need painkillers (for example paracetamol or ibuprofen), which you can buy from a pharmacy or shop. Sometimes stronger painkillers are needed and you may need a prescription from your doctor or nurse. Always follow the instructions on the packet.

You may need your ear cleaned out by a healthcare professional. They will look into your ear with a light or microscope, then clean your ear using gentle suction. You can read more about having microsuction.

A gauze (or wick) soaked in eardrops or ointment can be gently pushed into the ear canal. This helps to get the medicine into the whole ear canal if it is very swollen. Only a healthcare professional should do this. The gauze or wick is usually removed within 48 hours and then you need to continue the ear drops or spray continued for the prescribed course.

If the condition does not improve, your healthcare professional may take a swab (sample) to make sure that the most appropriate antibiotics are used to treat the infection.

If there is swelling of the outer ear, or if you have diabetes or any other conditions that affect your immune system (making you more prone to infection), your healthcare professional may prescribe antibiotic tablets.

If you do not get otitis externa treated

The ear infection may get worse and become very painful. It will become uncomfortable to move your jaw and further complications may develop (such as the infection spreading beyond your external ear).

How to avoid getting otitis externa

• Avoid getting water, soap or shampoo into the ear canal when having a bath or shower. Place a piece of cotton wool about the size of a 50 pence piece, coated with white soft paraffin (which you can buy at a pharmacy), at the entrance of both ear canals. Do not push the cotton wool down into the ear canal as it may be difficult to remove.
• To clean the outside of the ear, use a dry tissue, or alcohol-free baby wipes, around and behind the ear after showering or bathing.
• Make sure you never use cotton buds, tissues or material to soak up any moisture in your ears. Let them dry naturally.
• Do not use cotton buds, scratch or poke your ears, or insert anything into your ears.
• To keep your ears dry when swimming you may consider wearing a tight-fitting swimming cap over your ears. You can also try a headband, which will also help to keep cotton wool or earplugs in place.
• If your ears do feel wet after swimming you can use a hairdryer for a few minutes on the lowest setting. Hold the hairdryer about 20 cm (8 inches) from the outside of the ear to gently dry the ear canal.
• If you wear a hearing aid, wash the mould daily in warm soapy water while you are having treatment. Discuss with your hearing aid provider the benefit of the mould being vented (having a hole in the mould) to allow air into the ear canal when wearing the aid. Another option would be to have a hypo-allergenic mould, which contains material less likely to cause a reaction with the skin.
• If you accidentally get water in your ears, speak to your local pharmacist about treatments to reduce the chance of a recurring infection.
• If you have itchy or dry skin in your ear canals, speak to your local pharmacist or a healthcare professional about treatments available.
• If the entrance to the ear canal is dry or itchy, you may find it helpful to use a moisturiser around the bowl of the ear and at the entrance to the ear canal.
• Do not to use products from a shop if there is a chance that your eardrum may have a hole in it (perforated).

If the otitis externa does not settle after treatment, your ear should be checked by a doctor or nurse who specialises in ear, nose and throat (ENT) problems. Ask your GP to refer you to an ENT specialist.

If you frequently get otitis externa, it may be helpful to visit an audiologist (a specialist in assessing and treating ear and hearing problems). You can then have an impression taken of your outer ear for swimming plugs. The plugs create a seal against water getting into your ear. This service may be provided for you by the NHS. Ask your GP or practice nurse to refer you.