Outer ear infection (swimmer's ear)

 

Outer ear infection, known as otitis externa, is the infection of skin in the outer ear canal. It is sometimes referred to as swimmer's ear. Symptoms can include pain, itching, muffled hearing, and a feeling of blockage and ear pressure.  Treatment and prevention will normally include removing or avoiding the causes of irritation or blockage.

What is outer ear infection?

The ear is made up of three different sections: the outer ear, the middle ear, and the inner ear. These parts all work together so you can hear, and process sounds. The outer and middle ear are separated by the eardrum – a very thin piece of skin that vibrates when hit by sound waves.

 

This page deals with outer ear infection (otitis externa), a common condition that can affect people of all ages in which the skin that lines the outer ear canal is infected. This is normally a bacterial infection, but viral or fungal infections are also possible causes.   A separate page deals with middle ear infection (otitis media).

Causes

Outer ear infection can be caused by lack of ear wax, hot and humid weather, regular water exposure, and injury to the thin layer of skin in the outer ear canal often caused by use of cotton buds, hearing aids, or earbuds. 

Swimmers are particularly prone to developing an outer ear infection; hence, the condition is commonly known as swimmer's ear. Water that remains in the outer ear after swimming creates a moist environment that encourages bacterial or fungal growth. 

People with allergic conditions, such as eczema, psoriasis, hay fever, and asthma, are more likely to develop an outer ear infection. 

Symptoms

The most common symptoms of outer ear infection include: 

• Itching in the ear
• Redness and swelling inside the outer ear canal
• Feelings of pressure or fullness in the ear
• Muffled hearing 
• Mild to severe earache 
• Discharge from the ear.

You should see your doctor as soon as possible if signs or symptoms of outer ear infection appear. Delaying treatment can result in an advanced infection, with symptoms of severe pain around the face, neck, or side of the head, complete blockage of the ear, fever, and swelling of lymph nodes in your neck.

Discussion of your history and a physical examination are usually enough for your doctor to diagnose an outer ear infection. Your doctor might refer you to an ear, nose and throat (ENT) specialist if your eardrum has been damaged.

Some cases of outer ear infection are successfully treated by removal of any blockage or debris in the outer ear canal, while others may require use of corticosteroid and antibiotic ear drops to control inflammation and infection, and avoiding contributing factors (e.g., swimming, use of ear devices) until the infection has cleared. Moisture in the ear, and irritation of the skin in the ear canal, should be avoided.

Paracetamol or ibuprofen can be taken for pain relief. Your doctor may prescribe medications for more severe cases.

Prevention

The following ear hygiene practices can help to prevent outer ear infection: 

• Avoid inserting objects (e.g. cotton buds) into the ear canal 
• Avoid washing the ears with soap 
• Avoid swimming in polluted water (look for signs at beaches and lakes, or notifications on the Safeswim website, alerting swimmers to high bacterial levels
• Empty the ear canals of water after swimming or bathing by holding the head horizontally or using a hair dryer on a low setting. 

Frequent use of earplugs or earbuds can injure the ear canal, which may increase the chances of outer ear infection occurring.

References

Mayo Clinic (2019). Swimmer’s ear (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/swimmers-ear/symptoms-causes/syc-20351682 [Accessed: 11/01/21]
O’Toole, M.T. (Ed.) (2017). Otitis externa. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.
Waitzman, A.A. (2020). Otitis externa (Web Page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/994550-overview [Accessed 11/01/21]


Reviewed: January 2021