Otitis Externa

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Introduction

What is otitis externa?

Otitis externa is an infection of the outer ear canal and the external ear, which is known as the pinna. Otitis externa is commonly known as swimmer’s ear. Otitis externa can develop when water remains in the outer ear canal, most commonly after swimming. Moisture within the warm confines of the ear canal creates a friendly environment for the growth of bacteria, such as Pseudomonas, which can migrate into the ear and cause an infection. In addition, the water itself may be contaminated with bacteria or other organisms.

Common symptoms of otitis externa include itchy ears, redness of the outer ear, and pain that occurs when touching the ear or tugging on the earlobe. Other symptoms include yellow, greenish, or pus-like fluid draining from the ear and temporary hearing loss.

Swimming is not the only cause of otitis externa. Even water remaining in your ears after showering may allow the development of an infection. Other causes can contribute to swimmer’s ear, including an infection of the bone at the base of the skull, a foreign object lodged in the ear, and irritation from itching or cleaning the ear. Allergies to earrings or inflammatory skin conditions, such as eczema, can also produce symptoms of swimmer’s ear.

Symptoms of otitis externa should be evaluated by your health care provider. Seek prompt medical care if you experience any of the following symptoms, including fever; fluid draining from your ears; pain behind the ears; redness, burning, swelling or itching on or around the ear; or symptoms that persist despite treatment.

Symptoms

What are the symptoms of otitis externa?

Symptoms of otitis externa include pain, itching and irritation of the outer ear. You may also experience pus or other fluids draining from the ear. Temporary hearing loss can also occur.

Common symptoms of otitis externa

  • Drainage of fluid from the ear that is yellow, yellowish green, pus-like, or foul smelling

  • Itchy ears

  • Pain that is triggered by tugging on the ear lobe or outer ear

  • Redness of the ear canal

  • Temporary hearing loss

  • Swollen lymph nodes adjacent to ears

Symptoms that might indicate a serious condition

Symptoms of otitis externa should be evaluated by a health care provider. Seek prompt medical care if you, or someone you are with, have any of these serious symptoms including:

  • Fever
  • Fluid draining from the ears
  • Pain behind the ears
  • Redness, burning, swelling or itching in the outer ear
Causes

What causes otitis externa?

The causes of otitis externa, or swimmer’s ear, as the name suggests, include swimming or other situations in which water remains in the ear, creating a warm, moist environment that encourages the growth of bacteria. In addition, the water itself might be contaminated with bacteria or other organisms. The infection causes irritation and inflammation along the outer part of the ear and lobe, characterized by redness, burning, swelling and itching.

Swimming is not the only cause of swimmer’s ear. Water from other sources, such as showering, can remain in the ear and cause problems. Otitis externa can be also be the result of an infection of the bone at the base of the skull, a foreign object lodged in the ear, and irritation from itching or cleaning the ear. Allergies to earrings or skin conditions, such as eczema, can also produce symptoms of swimmer’s ear.

What are the risk factors for otitis externa?

A number of factors increase the risk of developing otitis externa. Not all people with risk factors will get otitis externa. Risk factors for otitis externa include:

  • Diabetes

  • Hearing aid use

  • Moisture remaining in the ear canal after showering, swimming, or other exposure to water

  • Narrow ear canal

  • Sensitivity to metals in jewelry

  • Swimming in a known source of polluted water

  • Use of cotton swabs to clean inside your ears

Reducing your risk of otitis externa

You can take several measures to reduce your risk of otitis externa including:

  • Avoiding getting water in your ears

  • Avoiding inserting cotton swabs or other objects into your ear to clean your ear canal

  • Avoiding swimming in contaminated pools, lakes or rivers

  • Drying your ears properly after a shower, swimming, or exposure to other forms of water

  • Instilling antiseptic eardrops (2% acetic acid with aluminum acetate) into ear canal after swimming

  • Wearing ear plugs while swimming

Treatments

How is otitis externa treated?

Your health care provider will likely prescribe antibiotic drops or ointments for otitis externa, as well as other possible medications and self-care measures.

Common treatments for otitis externa

Your health care provider may direct you to take the following:

  • Antibiotics or antifungal medications to treat the infection, which are commonly administered as ear drops

  • Pain-relieving medications, such as ibuprofen (Motrin, Advil) or acetaminophen (Tylenol)

  • Steroids to reduce inflammation

  • Your health care provider may suggest that you lie on one side while you administer ear drops. If the passage is too narrow or blocked with wax, your health care provider may use a wick to administer the medication.

What you can do to improve your otitis externa

In addition to consulting your health care provider, you can help improve your otitis externa by avoiding swimming, flying, scuba diving, or other activities that may aggravate your condition until symptoms have resolved.

What are the potential complications of otitis externa?

Left untreated, otitis externa can progress into more serious infections. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of otitis externa include the persistence or spread of the infection, leading to conditions such as:

  • Cellulitis (infection of the skin)

  • Chondritis (ear cartilage infection)

  • Chronic otitis externa

  • Inability to participate in water sports

  • Necrotizing otitis externa (potentially life-threatening infection)

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Ear problems. FamilyDoctor.org. http://familydoctor.org/familydoctor/en/health-tools/search-by-symptom/ear-problems.html.
  2. Swimmer's ear. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000622.htm.
  3. Stone KE. Otitis externa. Pediatr Rev 2007; 28:77.
  4. Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL (Eds), Textbook of Pediatric Infectious Diseases, 6th ed. Philadelphia: Saunders, 2009.
  5. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
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