Otitis Externa

Otitis externa is inflammation, irritation or infection of the outer ear canal (the tube between the outer ear and the ear drum). It is often called swimmer's ear because it can be caused by water that remains in the ear after swimming. This warm, moist environment promotes inflammation (redness and swelling) and bacterial growth. Otitis externa can also be brought on by putting fingers, cotton swabs or other objects in your ears.

Common symptoms include ear pain, itch, discharge, and some degree of temporary hearing loss. Although it is more common for only one ear to be affected, in some cases both ears become infected.

Usually you can treat swimmer's ear with eardrops. Prompt treatment can help prevent complications and more-serious infections. With treatment, these symptoms should clear up within a few days. However, some cases can persist for several months or longer.

Symptoms of otitis externa can vary between individuals. Common symptoms include:

• ear pain, which can be severe
• itchiness in the ear canal
• redness in the ear
• a discharge of liquid or pus from the ear
• some degree of temporary hearing loss
• ear may feel full or blocked
• sore and enlarged glands in the neck around the ear 
• fever

Although it is more common for only one ear to be affected, in some cases both ears become infected.

Most cases of otitis externa are caused by a bacterial infection, although the condition can also be caused by irritation, fungal infections and allergies.

• Having excess moisture in your ear after swimming or perspiring can provide an optimal environment for bacteria.
• Cleaning your ear with cotton swabs, or damaging the inside of the ear by other means can cause small breaks in the skin that allow bacteria to grow.

Long-term (chronic) swimmer's ear may be due to:

• Allergic reaction or sensitivity to something placed in the ear such as hair products or jewelry
• Chronic skin conditions such as eczema or psoriasis

See your healthcare provider if you think you have otitis externa. Your healthcare provider will usually not need lab tests to diagnose otitis externa. Diagnosis is usually based on symptoms and examination of the ear canal.

If necessary, a sample of fluid may be removed from the ear and sent to a lab to identify any bacteria or fungus.

During treatment, the following steps will help keep your ears dry and avoid further irritation:

• Avoid inserting cotton swabs and other things into your ears (including your fingers), as this can damage the sensitive skin in your ear canal.
• If you are a regular swimmer, protect your ears from water by using ear plugs and a swim cap. (Don't wear an earplug, hearing aid or headphones before pain or discharge has stopped.)
• Avoid getting water, soap or shampoo into your ears when bathing or showering.

There are a number of different types of ear drops that may be used to treat otitis externa, but they all tend to be used several times a day for about a week. 

Ear drops containing antibiotics are usually given, usually for 10 to 14 days.

• Acidic solution (e.g. vinegar) to help restore your ear's normal antibacterial environment
• Steroid to reduce inflammation
• Antibiotic to fight bacteria
• Antifungal medication to fight an infection caused by a fungus

To ease the discomfort of otitis externa, over-the-counter pain relievers, such as ibuprofen (Advil, Motrin, others), naproxen (Aleve, others), or acetaminophen (Tylenol, others) are sometimes recommended. Also, placing something warm against the ears may reduce pain.

If your pain is severe or your infection is at a more advanced stage, your healthcare provider may prescribe a stronger medication for pain relief.

Otitis externa sometimes heals without treatment, but it can take several weeks. However, with proper treatment, otitis externa symptoms usually improve within a few days.

Malignant otitis externa is an infection that spreads from the ear canal into the surrounding bone, requiring prompt treatment with antibiotics and sometimes surgery. Malignant otitis externa can be fatal if left untreated.