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Otitis Externa

(Swimmer’s Ear)

Definition

Otitis externa is redness and swelling of the ear canal. The ear canal is the tube leading from the outer ear to the eardrum.

Otitis externa may be:

  • Short-term (acute)
  • Long-term (chronic)

Some people develop malignant otitis externa. This is an infection of tissue and bone around the ear and skull base. If left untreated, it can be life-threatening.

Regions of the Ear
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Causes

Otitis externa is caused by infection, irritation, or damage to the ear canal.

Risk Factors

The acute type is more common in children. Risks for otitis externa are:

  • Getting water in the ear—especially from swimming or bathing
  • Sweating
  • Putting objects in the ear
  • Burns to the ear
  • Soap in the ear
  • Blockage in the ear canal from:
    • Impacted ear wax
    • Cysts
    • A defect, or too much ear hair
  • Having health conditions, such as:

Symptoms

This condition may cause:

  • Drainage from the ear
  • Redness or itching inside the ear canal
  • Pain in the ear
  • Hearing loss or a plugged-up feeling in the ear

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam may be done. The doctor will look in the ear with a lighted device. An ear swab may be done to check for infection.

If the doctor suspects malignant otitis externa, scans may be done, such as CT scan, MRI and bone scans. Other tests may also be done.

Treatment

The goal of treatment is to ease symptoms and clear any infection.

Options may be:

Medications

The doctor may advise:

  • Pain medicines
  • Antibiotic ear drops—to treat infection
  • Antifungal medicines by mouth— to treat fungal infections
  • Antibiotics by mouth or IV—for severe infections
  • Corticosteroid ear drops to reduce inflammation

If the ear canal is very swollen, a small sponge may be inserted in it. It will absorb the drops. It is usually removed after 24 to 48 hours.

If treatments do not work, drainage may be removed from the ear canal. This is rarely needed.

Surgery

Malignant otitis externa needs hospital care right away. Surgery may be needed if:

  • The infection spreads to the base of the skull
  • There is a bone abscess
  • Other treatments do not work

Dead tissue may also need to be removed.

Prevention

The risk of this condition may be lowered by:

  • Keeping water and objects out of the ear, if possible
  • Using acetic acid ear drops
  • Draining and drying ears after swimming or showering
RESOURCES:

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org

Family Doctor—American Academy of Family Physicians
http://familydoctor.org

CANADIAN RESOURCES:

Canadian Society of Otolaryngology
http://www.entcanada.org

Health Canada
https://www.canada.ca

REFERENCES:

Otitis externa. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/otitis-externa . Accessed January 29, 2021.

Otitis externa (swimmer's ear). National Center for Emergency Medicine Informatics website. Available at: http://www.ncemi.org/cse/cse0302.htm. Accessed January 29, 2021.

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 January 29, 2021.

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. Accessed January 29, 2021.

Last reviewed September 2020 by EBSCO Medical Review Board Shawna Grubb, RN  Last Updated: 2/22/2021