Outer ear infection (otitis externa)
Your health expert: Dr Mohamed Hariri, Consultant in Audio-Vestibular Medicine
Content editor review by Rachael Mayfield-Blake, December 2022
Next review due December 2025
An outer ear infection (otitis externa) is when your outer ear canal becomes inflamed, painful and itchy. Your outer ear canal is the tube that leads into your ear.
About outer ear infection
You can get an outer ear infection at any age; it affects both adults and children (usually when they’re between seven and 12). These infections tend to be particularly common in the summer months, especially in children. This may be because people are more likely to go swimming in summer, and getting water in your ear can sometimes lead to an outer ear infection.
Types of outer ear infection
Outer ear infections can be classified according to how long they last and how much of your ear canal is infected.
- Acute outer ear infections come on suddenly and usually go away within six weeks. They can come back (recur) after they’ve cleared up.
- Chronic outer ear infections cause ongoing symptoms that last for three months or more. This may affect your hearing.
- Localised otitis externa is when a hair follicle at the entrance to your ear becomes infected. It might cause a boil.
- Diffuse otitis externa is when the infection affects more of your ear canal, sometimes reaching as far as your eardrum. This type of outer ear infection is sometimes called swimmer’s ear because it often happens after you’ve spent time in water.
Causes of outer ear infection
Outer ear infection (otitis externa) is usually caused by bacteria. Sometimes it can be caused by a fungal infection, especially if you’ve recently had antibiotics for a bacterial infection. But anything that irritates the skin of your ear canal or causes an allergic reaction can also cause inflammation. Any of the following may make you more likely to get an outer ear infection.
- Damage to your ear canal – from a cotton bud, your fingernail or any other object
- Having too little earwax – often caused by too much cleaning. Some earwax is healthy because it protects the lining of your ear canal from dirt and dust and infections.
- Using hearing aids or earplugs – these can damage or irritate your ear canal, especially if they aren’t cleaned or don’t fit properly.
- Swimming, especially in polluted water because bacteria may get into your ear.
- If you live in a hot, humid climate, it may cause an outer ear infection known as tropical ear.
- Allergies or being sensitive to products like hairsprays and hair dyes which can irritate your ear canal.
- A narrow ear canal means that water can become trapped, and bacteria are then more likely to grow.
- A skin condition such as eczema or psoriasis means your skin is more likely to become infected.
- A condition that affects your immune system – for example, HIV/AIDS or diabetes.
Symptoms of outer ear infection
The most common outer ear infection symptoms include:
- pain in your ear – this can be severe, and may get worse when you push or pull your ear
- itching
- discharge from your ear
- reduced hearing – if the swelling is enough to block your ear canal
- pain in your jaw
- a full feeling in your ears
- a red or swollen ear canal
You can often manage the symptoms of an ear infection yourself at home with over-the-counter treatments, so you won’t always need to see a doctor. Ask a pharmacist for advice if you need it.
If your symptoms aren’t getting any better within a few days or if your symptoms are severe, contact a GP. This includes if you have:
- a high temperature (fever)
- discharge from your ear that looks yellow, smells bad and you have it for more than a few days
- significant hearing loss
- feel very unwell
Earwax removal
Bupa’s earwax removal service is a safe & effective way to remove earwax. Our Health Advisors are trained and accredited in ear wax removal, using a method called microsuction, which uses a specialist suction device and camera that looks inside your ear.
To book or to make an enquiry, call us on 0333 920 0881∧
Diagnosis of outer ear infection
A GP will usually be able to diagnose an outer ear infection by asking about your symptoms and examining your ear. They may also ask about your medical history to check if there’s anything that could have caused your symptoms.
The GP may look into your ear using an instrument called an otoscope to check for any signs of infection. They may ask you to move your ear or jaw to see if you feel pain.
If your symptoms are severe, don’t get better after treatment or come back, your GP may collect some discharge using a cotton swab. They’ll send this to a laboratory to find out whether the cause of your ear infection is bacterial or fungal.
Self-help for outer ear infection
If your outer ear infection is mild, you may be able to manage your symptoms yourself. The following home remedies may help.
- Don’t let shampoo, soap or water get into your ear. For example, put a cotton wool ball (coated with petroleum jelly) in your ears or use ear plugs when you have a shower or bath.
- Don’t use cotton buds or other objects to clean your ear. If you have discharge, use cotton wool to gently wipe it away, but don’t plug your ear with it. See a GP if you have a lot of discharge from your ear.
- If your ear canal is itchy, try not to scratch it because this can make the infection worse.
- Press a warm (but not wet) flannel (face towel) against the infected area as it may help to reduce pain.
- If your infection is related to a skin condition such as eczema or psoriasis, make sure you use your treatments for this as prescribed.
- Don’t go swimming for at least a week.
- Wear a tight-fitting swim cap or use ear plugs when you go swimming or do water sports.
There are also some over-the-counter medicines that you can buy (see our section on treatment for more information).
Treatment of outer ear infection
If you have a severe infection or your symptoms don’t clear up using self-help measures, you may need to see a GP for treatment. Most infections clear up quickly with the right outer ear infection treatment, but sometimes it can take several months to get rid of the infection.
Medicines for outer ear infection
Your GP may recommend or prescribe the following medicines to treat your outer ear infection and ease your symptoms.
- Over-the-counter painkillers such as paracetamol or ibuprofen may help to ease any pain. Ask a GP or pharmacist how long you can take these for if you have a long-lasting infection. If your pain is very bad, your GP may prescribe codeine.
- Over-the-counter ear drops or sprays for an outer ear infection. Acidic ear drops may help to clear up mild infections – you can buy these from a pharmacy and use them for up to a week.
- Prescription ear drops or sprays. A GP may prescribe ear drops or a spray that contains an antibiotic or an antifungal. Sometimes this is combined with a corticosteroid. You usually need to use these for at least a week and up to a maximum of two weeks.
- Antibiotic tablets or capsules (oral antibiotics). You don’t usually need oral antibiotics for outer ear infections. But your GP may prescribe them if you have a serious infection or an infection that can’t be treated with ear drops and sprays. Your GP may refer you to a specialist if you need oral antibiotics.
Always read the instruction leaflet that comes with your medicines. If you have any questions about your medicines and how to take them, ask a pharmacist.
Cleaning your ear canal
If earwax or loose material is blocking your ear canal, it can stop ear drops from working properly.
If you think you have too much earwax, don’t try to remove it yourself. If you use cotton buds or other objects to try to clean earwax out of your ears, it can push it further inside and block your ear. You might also damage the skin inside your ear canal, which can lead to an ear infection. You could use some olive oil or sodium bicarbonate wax eardrops to help to get rid of the wax.
A GP may suggest one of the following methods to clean your ear canal. Sometimes they may need to refer you to a specialist in ear, nose and throat conditions for these procedures.
- Dry swabbing. Dry cotton swabs are used to gently remove any loose material from your ear canal.
- Microsuction. A doctor or another trained specialist will use a device to gently suction out wax and any other material from your ear. They’ll use a microscope or camera to view your ear.
If your ear canal is very swollen, a doctor may suggest you have an ear wick put into your ear. This can usually only be done by a specialist. An ear wick is a small sponge pad. Once it’s in your ear, your doctor will soak it with an antibiotic solution, which allows drops to fall deep into your ear. The wick is usually left in place for at least a couple of days. Your doctor or nurse will usually remove it, but it may fall out on its own.
Complications of outer ear infection
Most outer ear infections clear up quickly with the right treatment. But sometimes an outer ear infection persists and may continue to cause symptoms for three months or longer. This is called a long-term (chronic) infection. In time, this can cause your ear canal to become narrowed or blocked and lead to hearing loss.
It’s possible for the infection to spread deeper into your skin (cellulitis) or form a large collection of pus (an abscess). You may need antibiotic tablets to treat this.
Malignant otitis
Rarely, an outer ear infection can start to affect the skin and cartilage around your ear, and nearby bones. This is called necrotising or malignant otitis externa. Despite its name, malignant otitis isn’t cancer.
Malignant otitis happens when your outer ear infection spreads from your ear to nearby tissues. This can lead to serious infections of your skin, bones, and the membrane surrounding your brain (meningitis). Most people who develop malignant otitis externa have an underlying problem with their immune system. For instance, they may have a weakened immune system due to HIV/AIDS, diabetes, chemotherapy or medicines that suppress the immune system.
If you have malignant otitis, your ear is likely to be very painful. You may also have:
- a high temperature (fever)
- headache
- foul-smelling ear discharge
- loss of movement of the muscles in your face
- hearing loss
If you have these symptoms, it’s important to seek medical help straight away. Malignant otitis can be life-threatening if it isn’t treated.
A doctor will usually give you antibiotics as tablets or drops, or as an intravenous drip (a drip in your arm) to treat malignant otitis externa. If you have a very serious infection, you may need surgery to remove any damaged tissue and bone.
Preventing outer ear infection
The following tips can help to reduce your risk of having an outer ear infection.
- Try to keep the inside of your ears dry by keeping shampoo and water out of your ears when you’re having a shower or a bath. Dry your ears with a dry towel or hair dryer (on the lowest heat setting) afterwards.
- Don’t use cotton buds or other objects to clean your ear canal.
- Use ear plugs and/or a tight-fitting swimming cap when you go swimming, to prevent water getting in your ears. Don’t swim in polluted water.
- Consider using acidic drops before and after swimming if you’re prone to outer ear infections. You can buy these from a pharmacy.
- If you have a skin condition such as eczema or psoriasis, make sure you keep it under control as much as possible.
- If you have a build-up of earwax, see a doctor or nurse to check if you need to get it removed. Don’t try to do it yourself.
Outer ear infections are usually caused by bacteria or fungi, or a reaction to something like shampoo or plastic earpieces. But anything that irritates the skin of your ear canal or causes an allergic reaction can cause inflammation and lead to an infection.
See our section on causes of outer ear infection for more information.
Acute outer ear infections come on suddenly and usually go away within six weeks. Chronic outer ear infections cause ongoing symptoms that last for three months or more. Most infections clear up quickly with the right treatment, but sometimes it can take several months to get rid of the infection.
See our section on types of outer ear infection for more information.
The most common symptoms of an outer ear infection include pain in your ear (which may get worse when you push or pull your ear). Other symptoms of an outer ear infection can include itching, discharge from your ear, and pain in your jaw.
See our section on symptoms of outer ear infection for more information.
You can treat the symptoms of a mild outer ear infection at home. For example, you can press a warm face towel against your ear to help reduce pain. If it doesn’t get better, you may need medicines such as acidic ear drops or antibiotics. Or a GP may prescribe antifungal ear drops or sprays combined with a corticosteroid.
See our sections on self-help for outer ear infection and treatment of outer ear infection for more information.
If your symptoms aren’t getting any better within a few days or if your symptoms are severe, contact a GP. If an outer ear infection doesn’t get better, it may lead to complications, and may start to affect your hearing.
See our section on complications of outer ear infection for more information.
The best medicine for an outer ear infection depends on what has caused it. If you have a bacterial infection, you may need ear drops or a spray that contains an antibiotic, whereas if you have a fungal infection, you may need antifungal ear drops or sprays. If you have a serious infection and these don’t work, your GP may refer you to a specialist for oral antibiotics (tablets).
See our section on treatment of outer ear infection for more information.
Antibiotics
Over-the-counter painkillers
Tinnitus
Acute middle ear infection in children
If you’re a parent you’ll probably know that middle ear infections are common in children, and unfortunately they’re often painful.
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