Otitis externa

People with otitis externa can experience some or all of the following symptoms:

• Pain/discomfort
• Discharge
• Blocked ear/hearing loss
• Itching
• Swelling of the outer ear (ear canal and pinna)

Most cases of otitis externa are caused by a bacterial infection (typically Pseudomonas aeruginosa or Staphylococcus aureus), although the condition can also be caused by fungal infections (e.g., thrush/Candida), allergy or local irritation.

The most common triggers are:

• Getting water, shampoo or soap into the ear canal can irritate the skin.
• Damage to the skin in the ear canal (caused by cotton buds, scratching or poking) causes inflammation and infection.
• Water getting into the ear canal while you are swimming (hence the term swimmer’s ear). The stagnant water triggers an infection.
• Hot humid weather makes inflammation of the ear canal more likely to develop.
• Skin problems such as eczema or psoriasis can increase the chance of developing problems with the ear canal.
• An increased build-up of wax in the ear canal can start to cause irritation, or water can become trapped behind the wax, causing infection.
• Wearing ear plugs, hearing aids or headphones preventing ventilation in the ears
• Chemicals contained within cosmetic products used locally such as hair sprays hair dyes and over the counter earwax softeners

Otitis externa can usually be diagnosed based on the typical symptoms described above. In persistent or recurrent cases, it may be necessary to take a swab of the discharge from the ear. This can be sent to the local pathology laboratory and may help identify which bacteria or fungal organism is causing the problem and which specific treatments are likely to resolve the infection.

Most people (including children) with otitis externa do not need antibiotics. That’s because research has shown that antibiotics make very little difference to how quickly you get better.

If you think that you/your child has otitis externa, you should consider using 2% acetic acid ear drops (e.g., Earcalm), which is an effective treatment for otitis externa. These are available without a prescription from your pharmacist.

If you/your child is still no better after a week of using acetic acid drops, then you should contact a GP who may consider starting antibiotic ear drops.

You can help relieve symptoms by:

• use painkillers such as paracetamol or ibuprofen (children under 16 should not take aspirin)
• place a warm or cold flannel on the ear
• remove any discharge by wiping the ear with cotton wool
• drink plenty of fluids

but

• do not put anything inside your ear to remove earwax, such as cotton buds or your finger
• do not let water or shampoo get in your ear
• do not use decongestants or antihistamines – there’s no evidence they help with ear infections

How to use ear drops

It is important to apply ear drops correctly as they may be less effective when applied in the wrong way:

• gently remove any discharge, earwax or debris from your outer ear using a twist of cotton wool
• warm the ear drops by holding them in your hands for a few minutes, as cold ear drops can make you feel dizzy
• lie on your side with your affected ear facing up before applying the drops directly into your external ear canal
• gently push and pull your ear for about 30 seconds to work the drops in and get any trapped air out
• stay lying down for three to five minutes, to ensure the ear drops don’t come out of your ear canal
• leave the ear canal open to dry

Prevention

• It is not possible to prevent ear infections; however, you can do things that may reduce the chances of developing the condition.
• Avoid getting water, soap or shampoo into the ear canal when having a bath or shower. Place a piece of cotton wool about the size of a 50 pence piece, coated with white soft paraffin (which you can buy at a pharmacy), at the entrance of both ear canals. Do not push the cotton wool down into the ear canal as it may be difficult to remove.
• To clean the outside of the ear, use a dry tissue, or alcohol-free baby wipes, around and behind the ear after showering or bathing. Never use cotton buds, tissues, or material to soak up any moisture in your ears. Let them dry naturally.
• Avoid cleaning the ears with cotton buds – this may damage and irritate the ear canal and pushes wax further into the ear. Wax is designed to come out by itself. Do not use cotton buds, scratch, or poke your ears, or insert anything into your ears.
• To keep your ears dry when swimming you may consider wearing a tight-fitting swimming cap over your ears. Headbands are also available to protect the ears from water. This will also help to keep cotton wool or earplugs in place.
• If you suffer from frequent bouts of otitis externa associated with swimming it may be helpful to use ear plugs. The plugs create a seal against water entry. These can be bought over-the-counter or can be tailored to a mould of your ear by an audiologist. This Service is not currently available from the NHS.
• If you wear a hearing aid, wash the mould daily in warm soapy water while you are having treatment. Discuss with your hearing aid provider the benefit of the mould being vented (having a hole in the mould to allow air into the ear canal when wearing the aid) or having a hypo-allergenic mould, which contains material less likely to cause a reaction with the skin.
• If you suffer from itchy or dry skin in your ear canals speak to your local pharmacist about treatments available.
• If the entrance to the ear canal is dry and/or itchy, you may find it helpful to place a moisturising ointment around the bowl of the ear and at the entrance to the ear canal.
• Do not to use over-the-counter products if there is a chance that your eardrum may be perforated (have a hole in it).
• Ensure children are up to date with their immunisations.
• Avoid exposing young children to smoky environments (passive smoking).
• Try not to give your child a dummy after they are 6 months old.

You should contact your GP if you or your child have:

• a very high temperature or feel hot and shivery
• earache that does not start to get better after 3 days
• swelling or redness around the ear
• fluid coming from the ear
• persistent hearing loss or a change in hearing
• other symptoms, like being sick, a severe sore throat or dizziness
• regular ear infections
• a long-term medical condition – such as diabetes or a heart, lung, kidney, or neurological disease
• a weakened immune system – because of chemotherapy, for example

Specialist management

If the symptoms of otitis externa are not settling, your GP may suggest taking a swab from your ear to try and clarify which infection is causing the problem. They may suggest prescription medication such as:

• antibiotic eardrops – to treat a bacterial infection
• steroid eardrops – to bring down swelling
• antifungal eardrops – to treat a fungal infection
• antibiotic tablets or medicine – if your bacterial infection is severe

In stubborn or persistent cases your GP may refer you to an ENT specialist or a nurse-led clinic to have the ear cleaned out using a suction device (micro-suction), this is known as aural toilet and allows a better examination of the ear drum and ear canal.

If you have been referred for a specialist opinion your details will be reviewed and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.

• Waiting times
• Find services near you