Outer ear infection: symptoms, causes and treatment

What is otitis externa?

Otitis externa is the medical term for inflammation or infection of the outer ear canal. This condition typically occurs when the skin inside the ear canal becomes damaged or irritated, allowing germs like bacteria or fungi to infect the area. The ear canal is particularly vulnerable to these infections due to its moisture retention, making it prone to issues like swelling, redness, and discomfort.

Why is it called swimmer's ear?

This condition can develop due to several causes, including exposure to water, which is why it’s commonly called swimmer's ear. However, it can also be triggered by other factors, such as excessive ear cleaning, allergies, or using ear devices like hearing aids or earplugs. Otitis externa can range from mild irritation to more severe cases involving pain and discharge, and its symptoms often improve with appropriate treatment.

Acute otitis externa

Acute otitis externa arises suddenly and is typically caused by a bacterial infection, often Pseudomonas aeruginosa. It is characterised by the rapid onset of severe ear pain, itching, redness, and sometimes discharge from the ear. The condition is frequently exacerbated by moisture, such as water trapped in the ear from swimming. Early treatment with anti-inflammatory ear drops or, in some cases, antibiotics, is essential to control the infection and prevent it from spreading or worsening.

Chronic otitis externa

Chronic otitis externa develops gradually, usually as a result of repeated acute infections or continuous irritation of the ear canal. Contributing factors may include persistent moisture exposure, allergies, or skin conditions like eczema. While symptoms tend to be milder than in the acute form, they can include ongoing itching, occasional discomfort, and intermittent discharge. Treatment focuses on managing the underlying cause, maintaining regular ear canal hygiene, and, when necessary, using medicated ear drops to control inflammation and prevent flare-ups.

Common symptoms of otitis externa

In a typical case of otitis externa, itching occurs first , followed by very severe, burning ear pain. Other signs of an ear canal infection can include the following symptoms:

Itchy feeling: an irritating itch inside the ear canal.
Temporary hearing loss: difficulty understanding quiet sounds or a feeling of muffled hearing.
Ear discharge: typically clear, white, or yellowish in colour.
Redness and swelling: the outer ear and ear canal may become inflamed and appear red.
Swollen and sore throat glands: in some cases, the lymph nodes around the throat may become swollen or tender.

Can otitis externa cause hearing loss?

Yes, otitis externa can cause temporary hearing loss, often due to swelling and blockage of the ear canal from infection or discharge. This typically resolves once the infection is treated, but if left untreated, it may lead to more prolonged hearing issues.

Can otitis externa cause dizziness?

Dizziness is not typically linked to otitis externa, as the condition primarily affects the outer ear, which is separated from the inner ear by the eardrum and ear canal. However, in rare cases, if the infection causes significant swelling near the eardrum, it may impact the balance mechanisms, leading to a sensation of dizziness.

Can otitis externa cause fever?

Otitis externa can cause a mild fever, especially if the infection is more severe or widespread.

Can otitis externa cause headaches?

Headaches are not typically associated with otitis externa, as the infection primarily affects the outer ear. However, the pain and discomfort caused by the inflammation in the ear canal can sometimes radiate, resulting in a headache. This is usually due to the pressure and swelling around the affected area.

Can otitis externa cause tinnitus?

Tinnitus, or ringing in the ears, can sometimes occur with otitis externa, especially if the infection causes significant irritation or swelling of the ear canal. While the tinnitus is often temporary, it may persist until the infection is treated.

Book an appointment to test your hearing health Book an appointment

Causes and triggers of otitis externa

Otitis externa can develop due to a variety of causes, many of which can be linked to environmental factors, personal habits, and underlying health conditions. Understanding these factors can help you avoid situations that may increase your risk of developing this condition.

Common triggers

Certain factors can increase the likelihood of developing otitis externa, making your ear canal more susceptible to infection. These include:

Overexposure to moisture (in activities like swimming), as well as excessive sweating or being in humid environments, can introduce bacteria or fungi into the ear canal.
Injuries to the ear canal, often from inserting cotton buds, earplugs, or earphones incorrectly, can damage the protective skin barrier, allowing germs to enter and cause infection.
Chemical irritant, such as hairsprays, hair dyes, or earwax softeners, can irritate the sensitive skin inside the ear canal, increasing the risk of inflammation and infection.
Underlying skin conditions like eczema, psoriasis, or acne can affect the skin in and around the ear canal, making it more prone to irritation and infection.

Common causes

Otitis externa can result from various infections and factors:

Bacterial infections: commonly caused by Pseudomonas aeruginosa, Staphylococcus aureus (including MRSA), Proteus vulgaris, and Escherichia coli. These bacteria thrive in moist environments, especially when the ear canal is damaged.
Fungal Infections (Otomycosis): less common, but caused by fungi like Aspergillus niger and Candida albicans, often after prolonged use of ear drops.
Allergies to ear medications, earplugs, shampoos, or cosmetics can irritate the ear canal, increasing infection risk.
Middle ear infections: discharge from otitis media can travel to the outer ear canal, causing otitis externa.
Seborrhoeic dermatitis: inflammation from this skin condition around the ear increases susceptibility to infection.
Infected hair follicles: bacterial infections, often by S. aureus, can cause painful boils in the ear canal.

Treatment for otitis externa

Treatment for otitis externa typically focuses on addressing the underlying infection, reducing inflammation, and relieving symptoms.

Mild cases often respond well to medicated ear drops containing antibiotics or antifungal agents, sometimes combined with steroids to reduce swelling and discomfort.
In more severe cases, the ear canal may need to be gently cleaned by a healthcare professional to allow the medication to work effectively.
Preventative measures, such as keeping the ear dry and avoiding trauma from cotton buds or earplugs, are essential to support recovery and reduce the risk of recurrence.

Can otitis externa go away on its own?

Mild cases of otitis externa may resolve on their own, especially if the underlying cause—such as trapped water or mild irritation—is addressed. However, most cases require treatment to prevent the infection from worsening.

Home remedies for ear canal inflammation

If you’re experiencing mild ear canal inflammation, certain tips and natural approaches may help reduce discomfort and support recovery. Here are some effective strategies:

Switch your sleep position: sleeping with the affected ear facing upward can promote drainage and reduce pressure. Elevating your head slightly with an extra pillow may also help.
Try neck exercises: gently stretching and rotating your neck can relieve tension in the muscles surrounding the ear, potentially easing inflammation and improving circulation.
Use ginger: ginger has natural anti-inflammatory properties. Apply freshly grated ginger juice around the outer ear to help reduce inflammation and pain.
Stay hydrated: drinking plenty of water helps maintain overall health and may assist in reducing inflammation.

These tips are intended for mild cases and should not replace medical care.

Can I wear my hearing aid if I have an ear infection?

If you have an ear infection, it’s best to avoid wearing closed hearing aids, such as in-the-ear hearing aids or behind-the-ear devices with closed ear moulds. These types of hearing aids create a sealed, warm, and moist environment in the ear, which can worsen inflammation and delay healing. Allowing your ear to stay ventilated and dry is crucial during the recovery process. If hearing aids are essential, consult your audiologist.

Take care of your hearing

If you’re concerned about your hearing, a professional check-up is strongly recommended

Find the nearest clinic

Get support and advice

Book a free hearing test

Book now

Test your hearing online

Take the test

Find your nearest store

Find a store

Otitis externa