Otitis externa (outer ear infection)

Otitis externa is caused by fungi or bacteria. Your outer ear can become infected, but there is not always a reason. However, there are some likely causes:

• Getting water, shampoo or soap into the ear canal can irritate the skin.
• Damage to the skin in your 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 also called swimmer’s ear. The stagnant water can provide a source for the growth of bacteria and fungi causing 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 your ear canal can start to cause irritation, or water can become trapped behind the wax and cause an infection.

Acute (sudden) otitis externa will usually clear within a week or so. 

Otitis externa can also be chronic (ongoing). This is usually because, even though you have had treatment for the infection, the underlying cause of it is still there. For example, a skin condition such as eczema.

• 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 your jaw when chewing or speaking
• Tinnitus (noises inside the ear, such as buzzing or ringing) 

• If needed, a healthcare professional will clean your ears to clear any discharge or debris.
• You may be prescribed eardrops, creams or sprays. 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 and finish the prescribed course.
• A dressing with treatment applied may be placed inside your ear canal if it is very swollen. This will be left in place for 1 to 4 days depending on the nurse’s recommendations. Only a healthcare professional should do this.
• 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.
• You may need pain medication (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 a healthcare professional. Always follow the instructions on the packet.
• If the infection has not responded to previous treatment, a swab (sample) may be taken to guide further treatment.

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).

It is not always possible to prevent otitis externa however, you can reduce the risk of developing an infection.

• Avoid getting water, soap or shampoo into your 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.
• Never use cotton buds, tissues or material to soak up any moisture in your ears. Let them dry naturally.
• Do not use cotton buds to scratch or poke your ears, or insert anything into your ears.
• To keep your ears dry when swimming, 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 your 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 your 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 getting another infection.
• If you have itchy or dry skin in your ear canals, this can be managed by applying an unscented moisturiser with the tip of your little finger to the entrance of your ears.
• If the entrance to your 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 be perforated (have a hole in it).

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.

You need urgent help

Go to your nearest Urgent and Emergency Care Centre (previously Accident and Emergency) or call 999 if you have any of the following symptoms:

• extreme, unmanageable pain
• pain, tenderness, swelling or redness to your mastoid bone area (the bone located behind the ear)

You need to contact a doctor or nurse today

Contact a doctor or nurse today if you have any of the following symptoms:

• you feel generally unwell, for example you have a high temperature or fever
• you feel your infection or symptoms have not improved or have got worse
• you are experiencing pain which is not managed with regular pain medication

You can contact the Ear care and Audiology Service Monday to Friday, 9am to 4pm (excluding Bank Holidays) on 01709 423207 or 01709 423145

Outside of these hours, or alternatively, please contact your GP surgery or NHS 111.

If you are not experiencing any of the above symptoms or problems

You should:

• continue with your treatment as prescribed/instructed
• take regular pain medication if needed
• attend your review appointment
• follow the advice given by the nurse or doctor

If you become concerned or need advice please contact the Ear care and Audiology Service, Monday to Friday, 9am to 4pm (excluding Bank Holidays) on 01709 423207 or 01709 423145.

Outside of these hours, or alternatively, please contact your GP surgery or NHS 111