Otitis Externa

Otitis externa is inflammation or infection of the outer ear canal, often called “swimmer’s ear” because it is commonly triggered by water exposure that disrupts the skin lining the canal.

• Ear pain, often worsened by touching or pulling the outer ear or jaw movement
• Itching in the ear canal
• Discharge from the ear, which may be clear, yellow, or foul-smelling
• Redness and swelling of the ear canal, sometimes narrowing it
• Temporary reduction in hearing if the canal becomes swollen or blocked with discharge or debris

• Most commonly caused by bacterial infection, and sometimes fungal infection, of the ear canal skin.
• Triggered or worsened by prolonged water exposure (such as swimming), humidity, or trauma to the ear canal from cotton buds, fingers, or other objects.
• Risk is increased by eczema or other skin conditions affecting the ear canal, and by use of hearing aids or earplugs that trap moisture.

• Diagnosed by examining the ear canal (otoscopy), typically finding redness, swelling, and discharge or debris confined to the outer canal, with an intact, normal-appearing eardrum where visible.
• Pain on gently pulling the outer ear or pressing the small cartilage flap in front of the ear canal (tragus) is a characteristic finding that helps distinguish it from a middle-ear problem.

Topical ear drops combining an antibiotic with a corticosteroid are the mainstay of treatment, applied for about a week, and are usually sufficient for most cases.

Keeping the ear dry and avoiding water exposure, swimming, and inserting objects into the ear canal during treatment supports healing.

Gentle cleaning of debris from the ear canal by a health worker, where needed, can improve how well ear drops reach the affected skin.

Cases that do not improve with initial treatment, involve significant swelling of the canal, or show signs of spreading infection (such as swelling or pain extending beyond the ear) are referred for further assessment, particularly in people with diabetes or weakened immunity, who are at higher risk of more serious spreading infection.

• Keep ears dry, and dry the ear canal gently after swimming or bathing.
• Avoid inserting cotton buds, fingers, or other objects into the ear canal.
• Consider ear plugs while swimming if prone to recurrent otitis externa.
• Avoid excessive or vigorous ear cleaning, which can damage the protective skin lining of the canal.