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Outer ear infection (otitis externa)


Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant
Next review due May 2021

An outer ear infection (otitis externa) causes pain, redness and swelling in your outer ear canal. This is the tube that leads into your ear. Outer ear infection is usually caused by bacteria. But they may also be caused by a fungal infection, irritation or eczema in or around your ear canal.

You can get an outer ear infection at any age. It tends to be particularly common in the summer months, especially in children. This may be partly because people are more likely to go swimming then, and getting water in your ear can sometimes lead to an outer ear infection.


Image showing the outer, middle and inner ear

Types of outer ear infection

An outer ear infection can last for a short time (acute) or for a long time (chronic).

  • Acute outer ear infections come on suddenly. They usually go away within six weeks, but the infection may then come back again.
  • Chronic outer ear infections cause ongoing symptoms that may last for several months or more. This can lead to permanent hearing loss.

An outer ear infection can affect a small part of your ear canal or most of your ear canal.

  • If you have localised otitis externa, a hair follicle at the entrance to your ear canal becomes infected, causing a boil.
  • 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 occurs after you’ve spent time in water.

Malignant otitis externa is a more serious outer ear infection. It mainly affects people with an immune system that doesn’t work so well, or if you have diabetes. Malignant otitis externa needs to be treated straightaway. For more information, see our FAQ further down the page: What is malignant otitis externa?

Symptoms of outer ear infection

Symptoms of an outer ear infection can include:

  • a red or swollen ear canal
  • dry skin or eczema in or around your ear canal
  • pain (earache), 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
  • a raised temperature
  • a full feeling in your ears

If you have any of these symptoms, contact your GP surgery. If you have severe pain and a high temperature or feel very unwell, see a doctor straightaway.

Diagnosis of outer ear infection

Your GP or nurse will ask about your symptoms and examine you. They may also ask about your medical history. They’ll check whether you have anything stuck in your ear or whether too much ear wax could be causing your symptoms. Your GP may also look for dry skin and eczema in or around your ear.

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

If your symptoms don’t get better after treatment or they come back, your GP or nurse may collect some discharge using a cotton swab. This will be sent to a laboratory for testing to find out whether bacteria or a fungus is causing your ear infection.

Treatment of outer ear infection

Most infections clear up quickly with the right treatment, but some can last for three months or longer.

Treating outer ear infections usually involves controlling your pain and reducing the inflammation. It also aims to stop the infection coming back. You may be prescribed ear drops and offered pain relief. There may be some self-help measures you can try while you’re using these treatments.

The right treatment for you will depend on how bad your infection is. It also depends on whether your infection is a short-term (acute) or a long-term (chronic) one. Your GP may need to refer you to a specialist, who can remove some of the discharge from your ear, before they can treat you properly.

Your symptoms will influence how quickly your infection clears up. If you have an acute infection, your symptoms should clear up completely within a week. If not, your GP will try another treatment.

If your infection keeps coming back, even after treatment, see your GP. They may refer you to a doctor who specialises in ear, nose and throat problems.

Medicines for outer ear infection

Your GP may recommend or prescribe several medicines to treat your outer ear infection and ease your symptoms.

Over-the-counter painkillers

You can take over-the-counter painkillers such as paracetamol or ibuprofen to help ease any pain. If you have a lot of pain, your GP may recommend a painkiller called codeine.

Acidic ear drops or sprays (such as acetic acid)

Acidic ear drops or sprays can stop several types of bacteria and fungi growing in your ear. These are often recommended for mild outer ear infections. You may also be recommended to use these with other treatments if you have a long-term (chronic) outer ear infection. You can buy some of these from a pharmacy without a prescription.

Antibiotic ear drops or sprays

The antibiotic may be combined with a corticosteroid. You usually need to use these for seven days. But if your symptoms don’t clear up completely, your doctor may recommend you use them for longer. Your doctor may also suggest switching from ear drops to a spray to see if that works better for you.

Antifungal ear drops or sprays

You may be prescribed these if your doctor can see signs of a fungal infection in your ear canal.

Antibiotic tablets or capsules

Oral antibiotics aren’t usually needed for outer ear infections. But your GP may prescribe them if you have a serious infection. You may be prescribed oral antibiotics if the infection is spreading outside your ear canal.

Corticosteroid-containing ear drops

These may reduce redness and swelling. But there’s not enough evidence to show they work well on their own for outer ear infections, so your doctor may only prescribe them in combination with other treatments.

Combination treatments

These ear drops usually contain a combination of corticosteroids, antibiotics and antifungals. They are recommended for more serious infections.

When you’re using ear drops, you may be asked to lie down with your affected ear facing upwards. Your doctor or nurse may also suggest you keep still for around 10 minutes after using ear drops or a spray. It may be difficult to get ear drops into your ear if your ear is swollen.

If you have dry skin or eczema in or around your outer ear, your doctor may prescribe a topical corticosteroid cream or ointment. You’ll need to use this sparingly.

Always read the instruction leaflet that comes with your medicines. If you have any questions, speak to your local pharmacist.

Self-help

There are some things you can do yourself to help recover from an outer ear infection.

If you have a lot of earwax, you may need to take ear drops. Don’t use cotton buds or other objects to clean out your ear. See ‘Cleaning your ear canal’ below.

If your ear canal is itchy, try not to scratch it, as this can make the infection worse. If you have a localised outer ear infection, pressing a warm (but not wet) flannel against the infected area may help to reduce pain. If you have a little discharge coming out of your ear, try not to plug your ear with cotton wool. If you have a lot of discharge, and do use cotton wool, keep the cotton wool loose and change it regularly.

Try to keep the inside of your ears completely dry. This includes keeping shampoo and water out of your ear when you’re having a shower or a bath.

Try not to swim while you have an outer ear infection. You should keep the inside of your ear as dry as possible until your infection has cleared up. If you do go swimming, use ear plugs and wear a tightly-fitting swimming cap. You shouldn’t do water sports for at least seven to 10 days while you have the infection.

If you have a dry skin condition, such as eczema or psoriasis, make sure this is well controlled by using your treatments as prescribed.

Cleaning your ear canal

If earwax or loose material is blocking your ear canal, this can stop ear drops from working properly. You may need to have your ear cleaned by a doctor or nurse before you use ear drops. This isn’t usually available at your GP practice, so you would need to be referred on to a specialist by your GP. It can help ear drops reach inside your ear and may prevent further infections.

Your GP may recommend that you have a procedure called microsuction. Microsuction is when a very small vacuum sucker is used to gently remove wax from your ear under a microscope. You may find it a little uncomfortable.

In other situations, people sometimes have ear wax removed by syringing. But your GP often won’t recommend this if you have an outer ear infection. If you have acute (short-term) infection, syringing may make things worse.

If your ear canal is very swollen, the specialist who your GP refers you to may put an ear wick in your ear to help. An ear wick is usually made of sponge. It is placed in your ear dry, before drops are put on it so it swells. This allows drops to fall deep in your ear, and puts gentle pressure on the walls of the swollen ear canal so it gradually settles. The wick is usually left in place for a couple of days, before your doctor or nurse removes it, or it may fall out on its own.

Causes of outer ear infection

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

Certain things may make you 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 – 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.
  • Having too little earwax (possibly from too much cleaning). Earwax protects the inside of your ears from infections.
  • A narrow ear canal, which means that water can become trapped and bacteria are more likely to grow.
  • Having a skin condition, such as eczema or psoriasis – broken skin is more likely to become inflamed.
  • Having a condition, such as diabetes, that means your immune system doesn’t work so well.

Complications of outer ear infection

Most short-term (acute) outer ear infections clear up with the right treatment. But sometimes they continue to cause symptoms for three months or longer, which is called a long-term (chronic) 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 necrotising or malignant otitis externa. This can damage the bone and cartilage around your ear. It’s most likely to affect older people and those with an immune system that doesn’t work so well (such as in diabetes). Malignant otitis needs to be treated straightaway. See our FAQ: What is malignant otitis externa?

Preventing outer ear infection

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

  • Dry your ears with a dry towel or 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.
  • Always tip out any water from your ears after swimming or having a bath or shower.
  • Use acidic drops from your pharmacist before or after swimming.
  • Avoid washing your ears with soap as this spoils the natural acidity of your ear canal.
  • Don’t swim in polluted water.

Frequently asked questions

  • If you have too much earwax, you shouldn’t try to remove it yourself. Using cotton buds or other objects to try to clean earwax out of your ears can push it further inside and block your ear. This can also cause an ear infection, as you may damage the skin inside your ear canal. So if you think you have too much earwax, ask your pharmacist 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). Earwax is made by glands that line your ear canal. It helps to clean your ears and protects them from damage and infections. Earwax usually works its way out of your ear naturally. But occasionally it may block your ear and dull your hearing. It may also cause ear infections.

    If your earwax is causing problems, speak to your local pharmacist. They may suggest using ear drops to soften the wax. The drops may contain sodium bicarbonate, olive oil or almond oil. Sodium bicarbonate ear drops tend to work the best, but they may dry out your ear canal. If your earwax doesn’t get better with drops, you could book an appointment with the practice nurse at your GP surgery. If needed, they’ll suggest an appointment with your GP, who can refer you for specialist ear cleaning. See our section on Cleaning your ear canal above for more details.

  • Malignant otitis externa is a serious condition that needs to be treated straightaway. It’s also called necrotising otitis. It happens when your outer ear 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. You may be more likely to get malignant otitis if you have problems with your immune system or have diabetes.

    If you have malignant otitis, your ear is likely to be very painful. You may also have a high temperature, headache, ear discharge and dizziness. You may also notice some loss of movement of the muscles in your face. If you have these symptoms, it’s important to seek medical help straightaway. Malignant otitis can be life-threatening if it isn’t treated.

    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). If you have a very serious infection, you may need surgery to remove any damaged tissue and bone and to drain any discharge.

  • You’ll need to lie down while you put your ear drops into your ear. Your pharmacist can show you how to use them properly.

    Below is a general guide.

    • Ask someone else to help put the ear drops into your ear if possible.
    • Make sure the ear drops are at room temperature before you use them – try warming them in your hand or pocket first 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 five to 10 minutes.


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Related information

    • Otitis externa. Clinical Knowledge Summaries. cks.nice.org.uk, last revised December 2016
    • Ear, nose and throat. Oxford Handbook of General Practice (online). Oxford Medicine Online. oxfordmedicine.com, published online April 2014
    • Otitis externa and painful discharging ears. PatientPlus. https://patient.info/doctor/otitis-externa-and-painful-discharging-ears, last checked October 2016
    • Otitis externa. BMJ Best Practice. bestpractice.bmj.com, last updated April 2017
    • ENT. Oxford Handbook of Operative Surgery. Oxford Medicine Online. oxfordmedicine.com, published online May 2017
    • External otitis (acute). The MSD Manuals. www.msdmanuals.com, last full review/revision September 2016
    • Otitis externa treatment and management. Medscape. emedicine.medscape.com, updated May 2017
    • Earwax. PatientPlus. patient.info, last checked May 2016
    • Ear. NICE British National Formulary. bnf.nice.org.uk, last updated September 2017
    • Malignant external otitis. The MSD Manuals. www.msdmanuals.com, last full review/revision September 2016
    • Olive oil. NICE British National Formulary. bnf.nice.org.uk, last updated September 2017
    • Otitis externa: topical ear preparations. Clinical Knowledge Summaries. cks.nice.org.uk, last revised December 2016

  • Reviewed by Graham Pembrey, Specialist Health Editor, Bupa Health Content Team, May 2018
    Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant
    Next review due May 2021



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