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Outer ear infection (otitis externa)


Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant
Next review due August 2023

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.


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About outer ear infection

Outer ear infection (otitis externa) is usually caused by bacteria. But it may be caused by a fungal infection, especially if you’ve already had antibiotics for a bacterial infection. There are non-infectious causes of ear inflammation such as allergies, irritants, and skin conditions such as eczema. Trauma (for example, from scratching) is also a cause of outer ear inflammation. For more information, see the Causes section.

You can get an outer ear infection at any age, but it’s most common in children aged seven to 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 then, 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 depending on 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 three weeks. They can come back (recur) after they’ve cleared up.
  • Chronic outer ear infections cause ongoing symptoms that last for at least three months or more. This may lead to some hearing loss.
  • Localised otitis externa is when just a hair follicle at the entrance to your ear has become 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 occurs after you’ve spent time in water.

Symptoms of outer ear infection

The most common symptoms of an outer ear infection 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
  • a full feeling in your ears
  • a red or swollen ear canal
  • dry skin or eczema in or around your ear canal

You can often manage symptoms of 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 your doctor. This includes if you have a high temperature, discharge from your ear, significant hearing loss or feel very unwell.

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Diagnosis of outer ear infection

Your 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.

Your 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 particularly severe or they don’t get better after treatment or they come back, your GP may collect some discharge using a cotton swab. This will be sent to a laboratory for testing to find out whether the cause of your ear infection is bacterial or a fungus.

Self-help

If your outer ear infection is mild, you may be able to manage your symptoms yourself at home, with advice from a pharmacist as necessary. The following measures may help.

  • Take over-the-counter painkillers such as paracetamol or ibuprofen to help ease any pain.
  • You can buy acidic ear drops from a pharmacy to help clear up mild infections.
  • 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 your 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.
  • 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 your infection is related to a skin condition such as eczema or psoriasis, make sure this is well controlled by using your treatments as prescribed.
  • Don’t go swimming for at least a week with an outer ear infection.

Treatment of outer ear infection

If you have a severe infection or your symptoms don’t clear up using the self-help measures above, you may need to see your GP for treatment. Most infections clear up quickly with the right 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. Your GP may recommend over-the-counter painkillers such as paracetamol or ibuprofen to help ease any pain. They may prescribe codeine if your pain is severe.
  • Ear drops or sprays. Your GP may prescribe ear drops or a spray containing an antibiotic or an antifungal. Sometimes this may be combined with a corticosteroid. You usually need to use these for at least seven days and up to a maximum of 14 days.
  • 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 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 your pharmacist. We have more information on applying ear drops in our FAQ: What is the best way to apply ear drops?

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, 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. You might also damage the skin inside your ear canal, which can lead to an ear infection.

Instead, your GP may suggest one of the following methods to clean your ear canal before you use ear drops. Sometimes they may need to refer you to a specialist in ear, nose and throat conditions for these procedures.

  • Syringing and irrigation. This gently washes out any earwax and debris blocking your ear canal.
  • Dry swabbing. This means using dry cotton swabs to gently remove any loose material from your ear canal.
  • Microsuction. This involves using a device to gently suction out wax and any other material from your ear. Your doctor will do this procedure using a microscope to view your ear.

If your ear canal is very swollen, your doctor may suggest inserting an ear wick into your ear. This can only be done by a specialist. An ear wick is a small sponge pad. Once it’s in your ear, it can be soaked with an antibiotic solution. This allows drops to fall deep into your ear. The wick is usually left in place for at least a couple of days. Generally, your doctor or nurse will remove it but 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 – from 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, especially in polluted water because this may introduce bacteria into your ear.
  • Living in a hot, humid climate – ear infection is often known as tropical ear.
  • Having allergies or 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 (often from too much cleaning). Earwax protects the inside of your ears from infections.
  • Having 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 that affects your immune system – for example, HIV/AIDS.

Complications of outer ear infection

Most outer ear infections clear up quickly with the right treatment. But sometimes an outer ear infection is harder to get rid of, 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.

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. It 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 taking 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, headache, ear discharge and dizziness. You may notice some loss of movement of the muscles in your face.

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.

You’ll usually be given antibiotics either as tablets 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 and to drain any discharge.

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.

Frequently asked questions about outer ear infections

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

  • Acute outer ear infections come on suddenly and usually go away within three weeks. Chronic outer ear infections cause ongoing symptoms that last for at least three months or more. If you have an ear infection and your symptoms aren’t getting any better within a few days you should contact your doctor.

  • The most common symptoms of an outer ear infection include:

    • painful, itchy ears
    • a full feeling in your ears
    • discharge from your ear
    • reduced hearing
    • redness, swelling, dry skin or eczema in or around your ear canal

    For more information see ‘symptoms of an outer ear infection’.

  • You’ll need to lie down while you put ear drops in, and it can help to have someone else put them in for you.

    • Make sure the ear drops are at room temperature before you use them because cold drops can make you feel dizzy. You can warm them in your hand or pocket first.
    • Lie down so that your infected ear is pointing upwards.
    • Apply the ear drops into your ear.
    • Gently pulling and pushing your ear may help the drops to get into your ear.
    • Try to remain lying down for three to five minutes.


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Related information

    • Otitis externa and painful, discharging ears. Patient. patient.info, last edited 19 October 2016
    • Otitis externa. BMJ Best Practice. bestpractice.bmj.com, last reviewed July 2020
    • Otitis externa. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised February 2018
    • Ear, nose and throat. Oxford handbook of general practice. Oxford Medicine Online. oxfordmedicine.com, published online June 2020
    • External otitis (acute). MSD Manuals. www.msdmanuals.com, last full review/revision Aug 2019
    • ENT. Oxford handbook of operative surgery. Oxford Medicine Online. oxfordmedicine.com, published online May 2017
    • Otitis externa. Medscape. emedicine.medscape.com, updated 9 March 2020
    • Earwax. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2016
    • Ear. NICE British National Formulary (BNF), bnf.nice.org.uk, last updated 30 July 2020
    • Malignant external otitis. MSD manuals. www.msdmanuals.com, last full review/revision August 2019
  • Reviewed by Pippa Coulter, Freelance Health Editor, August 2020
    Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant
    Next review due August 2023

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