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
Regions of the Ear
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Otitis externa is caused by infection, chemical irritation, or trauma. Trauma causes damage to the ear canal, which may cause inflammation or allow infection to invade.
Factors that may increase your chance of otitis externa include: Frequent swimming in chlorinated water, stagnant water, or increasingly warm waterNot rinsing all of the soap from the ear canal while showering or bathingYounger age with narrow ear canalsInsertion of any object into the ear canal causing damage to the liningSkin conditions, such as eczema, that cause breaks in the skin of the ear canal
Eardrum rupture from a middle ear infection—otitis media
DiabetesMedical 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
Otitis externa may cause: Redness and/or itching inside the ear canalPain in the ear, sometimes severe, that may worsen when chewing or talking, and with pulling on the earHearing loss or a plugged-up or pressure sensation of the earDrainage from the ear
Your doctor will ask about your symptoms and medical history, and perform a visual exam of the ear, including the ear canal and inner ear, using a lighted device called an otoscope. If malignant otitis externa is suspected, a
may be necessary.
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, where the infection can spread and cause malignant otitis externa.
Talk with your doctor about the best treatment plan for you. Options may include:
If you have an infection, medication will depend on the cause of the infection. Other medications will help reduce other symptoms, such as pain and inflammation. Your doctor may recommend: Oral nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammationAntibiotic ear drops to treat any infectionOral antifungal medications to treat fungal infectionsOral antibiotics to treat severe infections or cellulitis of the ear canalCorticosteroid 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 skullBone abscessFailure of other treatment methods
Debridement, the removal of dead tissue, may also be necessary to help the healing process.
Your doctor may also recommend: Keeping the ear dry for 7-10 daysTaking baths instead of showersAvoiding swimmingAvoiding rubbing or scratching the ear or inside the ear canalAvoiding using hearing aids or earplugs until you are healed
To help reduce your chance of otitis externa, or from 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.Avoid using 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.
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Otitis externa (swimmer's ear). National Center for Emergency Medicine Informatics website. Available at:
Accessed August 10, 2015.
Rutka J. Acute otitis externa: treatment perspectives.
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Swimmer’s ear. American Academy of Otolaryngology—Head and Neck Surgery website. Available at:
http://www.entnet.org/content/swimmers-ear. Updated December 2010. Accessed August 10, 2015.
Swimmer’s ear (otitis externa). Centers for Disease Control and Prevention website. Available at:
http://www.cdc.gov/healthywater/swimming/rwi/illnesses/swimmers-ear.html. Updated March 11, 2015. Accessed August 10, 2015.
Last reviewed September 2016 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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