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 swimmer’s 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:
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 paralysis.
Otitis externa may cause:
You will be asked 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 CT scan 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.
Options may include:
For those with an infection, medication will depend on the cause of the infection. Other medications will help reduce other symptoms, such as pain and inflammation. The doctor may advise:
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:
Debridement, the removal of dead tissue, may also be necessary to help the healing process.
The doctor may also advise:
To help reduce your chance of otitis externa, or from having the condition recur:
American Academy of Otolaryngology—Head and Neck Surgery
Family Doctor—American Academy of Family Physicians
Canadian Society of Otolaryngology
Otitis externa. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116943/Otitis-externa. Updated December 18, 2014. Accessed August 22, 2017.
Otitis externa (swimmer's ear). National Center for Emergency Medicine Informatics website. Available at: http://www.ncemi.org/cse/cse0302.htm. Accessed August 22, 2017.
Prentice P, et al. American Academy of Otolaryngology: head and neck surgery foundation clinical practice guideline on acute otitis externa 2014. Arch Dis Child Educ Pract Ed. 2015 Aug;100(4):197.
Rosenfeld RM. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. 2014 Feb;150(2):161-8.
Swimmer’s ear. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/content/swimmers-ear. Accessed August 22, 2017.
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 May 4, 2016. Accessed August 22, 2017.
Last reviewed September 2018 by EBSCO Medical Review Board Michael Woods, MD FAAP Last Updated: 9/30/2013