Otitis externa is an inflammation and/or infection of the ear canal. The ear canal is the tube leading from the outer ear to the eardrum. Because it is often found in swimmers, particularly in warm, humid climates, it is often referred to as swimmer’s ear.
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Factors that may increase your chance of otitis externa include:
- Frequent swimming in chlorinated water, stagnant water, or increasingly warm water
- Not rinsing all of the soap from the ear canal while showering or bathing
- Younger age with narrow ear canals
- Insertion of any object into the ear canal causing damage to the lining
- Skin conditions, such as eczema, that cause breaks in the skin of the ear canal
- Eardrum rupture from a middle ear infection—otitis media
- Medical conditions resulting in a compromised immune system
People with weak immune systems or who have a chronic illness, such as diabetes or HIV, may get an aggressive form called malignant otitis externa. Malignant otitis externa results in infection of the cartilage and bone around the ear, as well as between the ear and the brain (the skull base). The condition can be severe and difficult to treat, causing nerve paralysis.
This condition can easily be treated, but can become serious and life-threatening in some people if left untreated. This can be very serious, particularly in people with diabetes, whose infection can spread and cause malignant otitis externa.
Options may include:
For those with an infection, medication will depend on the cause of the infection. Other medications will help reduce other symptoms, such as pain and inflammation. The doctor may advise:
- Oral nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
- Antibiotic ear drops to treat any infection
- Oral antifungal medications to treat fungal infections
- Oral antibiotics to treat severe infections or cellulitis of the ear canal
- Corticosteroid ear drops to reduce inflammation (this may be combined with an antibiotic ear drop)
- Intravenous antibiotics for malignant otitis externa
If the ear canal is very swollen, it may not allow the ear drops to get in. A small sponge, called a wick, may be inserted in the ear canal to absorb the drops. It is usually removed after 24-48 hours.
If medications or ear wash do not work, your doctor may need to remove any drainage or pus from the ear canal. However, this is rarely needed.
Malignant otitis externa requires immediate treatment, hospitalization, intravenous antibiotics, and possibly surgery. Surgery may be indicated for:
- Infection that has spread to the base of the skull
- Bone abscess
- Failure of other treatment methods
Debridement, the removal of dead tissue, may also be necessary to help the healing process.
The doctor may also advise:
- Keeping the ear dry for 7-10 days
- Taking baths instead of showers
- Avoiding swimming
- Avoiding rubbing or scratching the ear or inside the ear canal
- Avoiding using hearing aids or earplugs until you are healed
To help reduce your chance of otitis externa or of having the condition recur:
- Avoid swimming in unclean water.
- Thoroughly drain and dry the ear and ear canal after swimming or showering.
- When showering, gently place a cotton ball lightly coated with petroleum jelly into the outer ear to prevent water collection.
- Do not insert anything into the ear canal, including your finger or cotton swabs.
- Do not remove earwax. If you are having problems hearing, see a doctor first.
- Limit use of earplugs, since they can irritate the lining of the ear canal and can trap water inside the ear.
- Consider using a tight-fitting swimming cap.
- Use a white vinegar/rubbing alcohol ear drop solution following swimming or glycerin drops before and after swimming. This will help restore the natural healthy environment inside the ear canal.
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
Edits to original content made by Denver Health.
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a (Swimmer’s Ear)
American Academy of Otolaryngology—Head and Neck Surgery http://www.entnet.org
Family Doctor—American Academy of Family Physicians http://familydoctor.org
Canadian Society of Otolaryngology http://www.entcanada.org
Health Canada http://www.hc-sc.gc.ca
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