Otitis externa, also known as swimmer’s ear, is inflammation (often due to infection) of the skin of the outer ear, which includes not only the visible ear but also the portion of the ear canal that leads up to the eardrum. In some cases, the inflammation may be localized, producing a boil.

Although it can be very painful and unpleasant, otitis externa is generally not serious and responds well to treatment. However, in people with diabetes, the elderly, and those with weakened immune systems, the disease can produce malignant otitis externa, a rare, noncancerous (despite its name) form of this disorder. Malignant otitis externa may spread to surrounding bones and soft tissues and can be fatal if not treated.

What Causes Outer Ear Infection?

• Moisture in the ear fosters fungal and certain kinds of bacterial infections. Swimming, especially in contaminated water, thus increases the risk of otitis externa. Showering, washing your hair, or getting caught in the rain is less likely to raise risk.

• Skin disorders, such as eczema or seborrheic dermatitis, may cause inflammation.

• Objects inserted into the ear, like cotton swabs, may irritate the skin or cause small cuts that are vulnerable to infection.

• Inadequate production of earwax renders the ear more vulnerable to infection.

• Earwax removers, hair dyes, shampoos, hairsprays, or chlorinated water may irritate the ear canal.

Symptoms of Outer Ear Infection

• Itching in the ear canal in the early stages

• Ear pain that may become intense. The ear is tender to the touch and pain worsens when pulling the ear.

• Discharge of drainage (fluid or pus) from the ear canal

• Redness and swelling of the skin of the ear canal (and occasionally of the external ear) to the point of closure of the ear canal

• A small, painful lump or boil in the ear canal

• Temporary hearing loss due to swelling and pus accumulation in the ear canal

• Fever

• Swollen glands (lymph nodes) in the neck

Prevention of Outer Ear Infection

• Do not insert objects, even cotton swabs, into the ear canal, and do not clean the ear with alcohol or over-the-counter solutions. (Your doctor can remove earwax safely.)

• If you experience frequent itching of the ear canal, consult a doctor. Control of an underlying skin condition can prevent secondary infection.

• Avoid swimming in waters that may be polluted and wear a tight fitting swimming cap to prevent water from entering in the ear canal.

• If there has been contact with water that might cause otitis externa, swabbing the ears with white vinegar may prevent infection.

Outer Ear Infection Diagnosis

• The doctor will examine the ear canal through an otoscope, a small, lighted viewing instrument.

• In some cases, a CT scan or MRI scan of the head, x-rays of the skull or a radionuclide scan can be performed to detect signs of a bone infection near the ear canal.

• A culture of fluid discharge may be taken.

How to Treat Outer Ear Infection

• Over-the-counter pain relievers may be taken. (Children should take acetaminophen, not aspirin.)

• Your doctor may use a small suction device to remove excess fluid and pus from the ear canal.

• Topical antibiotics or antifungal ear drops may be prescribed to treat infection, in addition to corticosteroid drops to reduce inflammation. A spongelike wick may be inserted into the ear to allow medication to travel deeply into the ear canal. Finafloxacin otic suspension (Xtoro) was approved by the U.S. Food and Drug Administration (FDA) in December 2014 to treat acute otitis externa.

• Oral antibiotics may be given for severe infection.

• Surgical removal of dead tissue may be required to treat malignant otitis externa.

• Codeine or narcotics may be prescribed to relieve severe pain.

• After symptoms disappear, avoid getting water into the ear canal for up to three weeks; protect your ears when showering and avoid swimming.

• In the event of recurrence, keep a supply of the prescription ear drops on hand to ease symptoms.

When to Call a Doctor

Call a doctor if symptoms persist for more than a day or two. (People with diabetes should notify a doctor at the first sign of an ear infection.)