What is Otitis Externa?

Otitis externa is a common bacterial infection of the external ear canal that can cause ear pain. The condition can also cause swelling of your external ear canal. Otitis externa usually only affects one ear.

This condition is referred to as "swimmer's ear" because it affects those who spend a lot of time in the water. High exposure to water, along with humidity, makes the ear more susceptible to otitis externa. Anyone who spends extended periods in water — such as surfers, swimmers, and scuba divers—is at higher risk for developing Otitis externa.

Symptoms

Otitis externa symptoms can be mild, moderate, or severe. The symptoms generally get worse as the condition progresses without treatment.

Mild symptoms:

• Modest drainage
• Some itching
• Slight discomfort
• Minimal redness inside ear

Moderate symptoms:

• Increased drainage
• More intense itching
• Excessive drainage
• Worsening pain
• Reduced hearing
• “Full” feeling

Severe symptoms:

• Intense pain
• Fever
• Swollen lymph nodes
• Total ear obstruction
• Redness outside of ear

The pain associated with otitis externa is sometimes called “water in ear pain” or “swimmer’s ear pain.” The pain is usually described as aching, sharp, or stabbing. In the early stage, the pain may come and go. Some people only feel ear pain at the beginning of the illness. Others experience a continuous earache.

Causes

Otitis externa is primarily caused by a bacterial infection, but there are also other causes and risk factors.

Otitis externa causes:

• Allergies — Allergies cause otitis externa by irritating and drying the ear canal, which makes it even more susceptible to infection.
• Fungal infections — When fungi grow out of control, they may irritate the skin of your outer ear.
• Irritation — Anything that irritates your outer ear canal can cause otitis externa, including excessive use of ear wax removal products and scratching your ear because your ear itches.

Otitis externa risk factors:

• Water in your ear
• Using hearing devices
• Extreme ear cleaning
• Damaging your inner ear

Water inside your ear provides a breeding ground for bacteria. It also increases the likelihood that you might scratch your ear, which can unintentionally result in damage. 

Diagnosis

Your doctor can usually make an otitis externa diagnosis during a regular office visit. A diagnosis usually involves your doctor inspecting your ear canal and your ear drum.

Common diagnostic measures:

• Inspecting your ear canal — Your doctor may use a medical tool affixed with a light to examine your ear canal. Your doctor will look for redness, swelling, and debris.
• Examining your ear drum — Your doctor will inspect your ear drum for damage or obstructions.

Additional testing may be needed if your condition is severe or if you do not respond to initial treatments.

Treatment

There are several common forms of otitis externa treatment. There are also ways to manage swimmer’s ear. Your doctor may also refer to treatment as swimmer’s ear treatment or swimmer’s ear pain relief.

Treatment for otitis externa:

• Clear the ear canal — If there is a blockage in your ear canal, your doctor will remove the blockage. Sometimes this involves clearing pus or excess drainage.
• Ear drops — Your doctor will likely prescribe antibiotic ear drops to fight the infection in your ear. You can expect to use ear drops for 7 to 14 days.
• Medication — Your doctor might prescribe medication to reduce your pain and reduce swelling in your affected ear. If the ear infection has spread further inside of your body, your doctor may prescribe oral antibiotics.

Complications

Otitis externa complications are rare. Left untreated, the condition can worsen and lead to serious swimmer’s ear complications. 

One serious condition is called necrotising otitis externa. This is where the infection spreads to the bone around your ear canal. Without immediate treatment, you might experience facial paralysis. 

Prevention

You can take steps to help prevent otitis externa. Some of these preventive methods help avoid an ear infection after swimming.

Preventive measures:

• Avoid inserting anything into your ear — including fingers or cotton swabs.
• Drain water from your ears after showering or swimming.
• Use shower caps to keep your ears dry.
• Avoid polluted water.
• Avoid swallowing swimming water.
• Try to keep your ears dry.
• Avoid regularly swimming underwater.