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Outer ear infection (otitis externa)

At least one in every 100 people will get an outer ear infection each year. The medical term for an outer ear infection is otitis externa. This means inflammation of your outer ear canal (the tube that leads into your ear). 

Types of outer ear infection

An outer ear infection can be acute or chronic. When describing a condition, the words ‘acute’ and ‘chronic’ refer to how long you’ve had it, not to how serious the condition is. An acute outer ear infection comes on suddenly and usually goes away within three weeks. Chronic outer ear infection causes ongoing symptoms that may last for several months.

Sometimes, a hair follicle at the entrance to your ear canal can become infected, causing a boil. This is called localised otitis externa.

If an infection affects more of your ear canal and reaches your eardrum, this is called widespread or diffuse otitis externa. This type of outer ear infection is sometimes called swimmer’s ear because it often develops after you’ve spent time in water.

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Image showing the outer, middle and inner ear

Details

  • Symptoms Symptoms of outer ear infection

    Symptoms of an outer ear infection can include:

    • pain (ear ache), which may get worse when you push or pull your ear
    • itching
    • discharge from your ear
    • temporarily dulled hearing – if the swelling is enough to block your ear canal

    If you have any of these symptoms, contact your GP surgery.

  • Diagnosis Diagnosis of outer ear infection

    Your GP or nurse will ask about your symptoms and examine you. They may also ask you about your medical history.

    Your GP or nurse may look into your ear using an instrument called an otoscope to check for swelling and infection. They may ask you to move your ear or jaw to see if you feel pain.

    If your symptoms don’t improve after treatment or they come back, your GP or nurse may take a sample from the area using a swab. This will be sent to a laboratory for testing to find out whether a bacteria or fungus is causing your ear infection.

    If your infection keeps coming back despite treatment, see your GP. They may refer you to a specialist.

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  • Treatment Treatment of outer ear infection

    Treatment usually involves controlling your pain and treating the inflammation. The treatment you have and how quickly your infection clears up will depend on how severe it is. Most treatments work within a few days.

    Medicines

    The following medicines can help relieve and treat the symptoms of an outer ear infection.

    • Over-the-counter painkillers (eg paracetamol or ibuprofen) can relieve pain. If your pain is greater, your GP may recommend a medicine called codeine.
    • Acidic ear drops or spray (such as acetic acid) can stop several types of bacteria and fungi growing in your ear. You can buy some of these from a pharmacist without a prescription. They’re often used to treat mild infections.
    • Antibiotics and antifungals can treat a bacterial or yeast infection. These are usually prescribed as ear drops but your GP may prescribe tablets if you have a severe infection.
    • Steroid-containing ear drops can reduce swelling in your ear.
    • Combination ear drops. Ear drops for infections that are more severe usually contain a combination of steroids, antibiotics and antifungals. Some come in a spray rather than drops.

    You may need to have your ear cleaned by your specialist or nurse before you use the ear drops. For example, you may need to have your earwax removed by microsuction. This is when a very small vacuum sucker is used to gently remove wax from your ear under a microscope.

    You may be asked to lie down with your affected ear facing upwards when you use ear drops. Sometimes, it’s advised to keep still for three to five minutes after using ear drops or a spray. It may be difficult to get ear drops into your ear if your ear is swollen.

    Your doctor or nurse may put an ear wick in your ear to help. An ear wick is usually made of sponge or gauze. It may be soaked in ointment before being put in your ear, or you might put drops onto it once it’s in place. This wick helps your treatment get to the affected part of your ear. An ear wick is usually fitted and removed in hospital. It’s usually left in place for a couple of days, before your doctor or nurse removes it. You may be shown how to remove the wick yourself.

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  • Causes Causes of outer ear infection

    Outer ear infections are usually caused by an infection of bacteria or fungi. Anything that irritates the skin of your ear canal or causes an allergic reaction can also cause inflammation.

    The following factors can mean you’re more likely to get an outer ear infection.

    • Damage to your ear canal – with a cotton bud, your fingernail or any other object.
    • Using hearing aids or earplugs – these can damage or irritate your ear canal or introduce bacteria.
    • Swimming often – this can wash away your earwax, which then makes it easier for bacteria to grow there.
    • Swimming in polluted water – this may introduce bacteria into your ear.
    • Living in a hot, humid climate – the infection is then known as tropical ear.
    • Being sensitive to products like hairsprays and hair dyes – these can irritate your ear canal.
    • A build-up of earwax in your ear canal, or accidentally pushing wax into your ear when cleaning it. This can trap water in your ear, making it damper and more likely to get infected.
    • A narrow ear canal, which means that water can become trapped and bacteria are more likely to grow.
    • Having a skin condition, such as dermatitis or psoriasis – broken skin is more likely to become inflamed.
  • Complications Complications of outer ear infection

    Infections can spread across your skin (cellulitis) or form a large collection of pus (an abscess). If left untreated, an outer ear infection can cause temporary deafness. This is because your ear canal can become narrowed or blocked.

    Rarely, an outer ear infection can become a more severe infection called malignant otitis. See our FAQs section for more information about this.

  • Prevention Prevention of outer ear infection

    The following tips can help to reduce your risk of having an outer ear infection.

    • Dry your ears with a hair dryer (on the lowest heat setting) after washing.
    • Don’t use cotton buds or other objects to clean your ear canal.
    • If you use ear plugs regularly, clean them after use with alcohol.
    • Use ear plugs when you go swimming.
    • Use acidic drops before or after swimming (such as a mix of alcohol and vinegar).
    • Avoid washing your ears with soap as this spoils the natural acidity of your ear canal.
    • Don’t swim in polluted water.
  • FAQ... I seem to get a lot of earwax. How can I get rid of it? FAQ... I seem to get a lot of earwax. How can I get rid of it?

    Answer

    You shouldn’t try to remove earwax yourself. Earwax helps to clean your ear and is acidic, protecting your ear from infections. Trying to remove wax can damage your ear.

    More detail

    Earwax is produced by the glands that line your ear canal. It’s there to protect your ear and normally works its way out naturally. Occasionally, earwax may block your ear and dull your hearing.

    Using cotton buds or other objects to try to clean earwax out of your ears can push it further inside and block your ear. Trying to remove earwax yourself can also cause an ear infection, as you may damage the skin of your ear canal.

    If you think you have a problem with earwax, ask your GP for advice. Earwax doesn’t normally need to be removed unless it’s giving you earache, affecting your hearing or making you feel dizzy (vertigo). Your GP may suggest using ear drops to soften the wax. These could be made of sodium bicarbonate, sodium chloride, olive oil or almond oil. If your earwax doesn’t improve with drops, your GP may suggest you have your ear syringed.

    When your ears are syringed, your GP will carefully squirt lukewarm water into your ear canal to dislodge your earwax. Ear syringing itself can cause an ear infection. It isn’t recommended as a treatment if your ear canal has been inflamed or damaged before or if you have a hole in your eardrum. It also isn’t recommended for people with diabetes as it may increase the risk of you getting a more severe infection called malignant otitis.

    If syringing doesn’t work, you can have your earwax removed by microsuction. This is usually done by a hospital nurse or a specialist. Under a microscope, a very small vacuum sucker is used to gently remove wax from your ear.

  • FAQ... What is malignant otitis and how is it treated? FAQ... What is malignant otitis and how is it treated?

    Answer

    Malignant otitis is a rare condition which is treated with antibiotics. Surgery is sometimes needed to remove parts of damaged bone or tissue.

    More detail

    Malignant otitis is a rare condition. It happens when your infection spreads from your ear to nearby tissues. This can lead to serious infections of your bones, the membrane surrounding your brain (meningitis), and skin. It can be life-threatening without treatment. If you have problems with your immune system or have diabetes, you may be more likely to get malignant otitis.

    If you have malignant otitis, it’s likely to be very painful. You may have a headache, ear discharge or some loss of movement of your facial muscles. You’ll need tests in hospital to confirm whether you have malignant otitis.

    These may include the following.

    • A CT scan. A scan that uses X-rays to make a three-dimensional image of your body.
    • A bone scan. This uses an injection of radioactive solution followed by scanning to make an image of your bones.
    • An MRI scan. A test that uses magnets and radio waves to produce images of the inside of your body.

    You may also have blood tests, a biopsy and a sample of any ear discharge tested for bacteria. A biopsy involves removing a sample of cells or tissue to confirm your diagnosis.

    Malignant otitis can be treated with antibiotics. These will usually be given as ear drops as well as either tablets or an intravenous drip (a drip in your arm). You might also need surgery to remove any damaged tissue and bone, and to drain any fluid.

  • FAQ... What is the best way to apply ear drops? FAQ... What is the best way to apply ear drops?

    Answer

    You’ll need to lie down while you apply your ear drops. This is so the drops do not run out of your ear.

    More detail

    Your pharmacist will explain how to apply your ear drops. Below is a general guide.

    • Have someone else’s help to place the ear drops if possible.
    • Ensure the drops are at room temperature, as cold drops can make you feel dizzy.
    • Lie down so that your infected ear is pointing upwards.
    • Place the ear drops in your ear.
    • Softly pulling and pushing your ear may help the drops to get into your ear.
    • Try to remain lying down for three to five minutes.
  • Resources Resources

    Further information

    Sources

    • Otitis externa. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published April 2015 
    • Otitis externa. BMJ Best Practice. www.bestpractice.bmj.com, published 24 April 2015 
    • Otitis externa (acute). The Merck Manuals. www.merckmanuals.com, accessed 2 June 2015 
    • Otitis externa. Medscape. www.emedicine.medscape.com, published 29 December 2014 
    • Earwax. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published May 2012 
    • Map of Medicine. Otitis externa. International View. London: Map of Medicine; 2011 (Issue 2) 
    • Otitis externa and painful discharging ears. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 15 October 2013 
    • Bone scanning technique. Medscape. www.emedicine.medscape.com, published 23 May 2014 
    • Personal communications. Mr Anil Banerjee, Assistant Medical Director, University Hospitals of Leicester, July 2015  
    • Infections of the ear. ENT UK. www.entuk.org, accessed 9 July 2015 
    • Rizzo, D. Fundamentals of anatomy and physiology. 4th ed. Boston, USA: Cengage Learning; 2015
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