An outer ear infection is an infection of the outer opening of the ear and the ear canal that connects the outside of the ear to the eardrum. It is medically known as otitis externa. One common type of otitis externa is referred to as “swimmer’s ear.” This outer ear infection often results from exposure to moisture. It’s common in children, teens, and adults who spend a lot of time swimming. Swimmer’s ear results in nearly 2.4 million healthcare visits annually in the United States.
Swimming (or possibly even bathing or showering too frequently) can lead to an outer ear infection. The water left inside the ear canal can become a breeding ground for bacteria.
An infection can also occur if the thin layer of skin that lines the ear canal is injured. Intense scratching, using headphones, or placing cotton swabs in your ear can damage these delicate cells. When the layer of skin becomes damaged and inflamed, it can provide a foothold for bacteria.
Cerumen, or earwax, is the ear’s natural defense against infection, but constant exposure to moisture and scratching can deplete the ear of cerumen, making infections more likely.
Symptoms of otitis externa include:
- pain or discomfort in the ear
- discharge of pus
- excessive fluid drainage
- muffled or diminished hearing
Severe pain in the face, head, or neck can signify that the infection has advanced considerably. Symptoms accompanied by a fever or swollen lymph nodes may also indicate advancing infection. If you have ear pain with any of these symptoms, see your doctor right away.
Swimming is the biggest risk factor for otitis externa, especially swimming in water with high levels of bacteria. Pools that are adequately chlorinated are less likely to spread bacteria.
Showering or cleaning your ears too frequently can also leave the ears open to infection. The narrower the ear canal, the more likely it is that water will be trapped inside. Children’s ear canals are typically narrower than adult ear canals. The use of headphones or a hearing aid, as well as skin allergies, eczema, and skin irritation from hair products, also increase the risk of developing an outer ear infection.
Swimmer’s ear is not contagious.
Outer ear infections may heal on their own without treatment. Antibiotic eardrops are the most common treatment for an outer ear infection that has not healed on its own, and can be prescribed by your doctor. Doctors may also prescribe antibiotic drops mixed with steroids to reduce swelling in the ear canal. The ear drops are typically used several times a day for seven to 10 days.
If a fungus is the cause of the outer ear infection, your doctor will prescribe antifungal ear drops. This type of infection is more common in people with diabetes or a depleted immune system.
To reduce symptoms, it’s important to keep water out of the ears while the infection is healing. Over-the-counter pain medications like ibuprofen or acetaminophen can be used to reduce pain. In extreme cases, prescription pain medication may be prescribed.
The most important part of home treatment for outer ear infections is prevention. Keeping the ear dry as much as possible decreases the risk of infection. Tips to keep in mind include:
- using a cotton ball or soft ear plugs to prevent water from entering the ear while showering or bathing
- using a swim cap
- avoiding scratching the inner ear, even with cotton swabs
- avoiding removing ear wax on your own
- using an eardrop mixture of rubbing alcohol and/or vinegar after swimming to help dry up excess water (a mixture of 50 percent rubbing alcohol, 25 percent white vinegar, and 25 percent distilled water)
- towel-dry head and ears after swimming
Children, especially those who spend a lot of time in the water, are particularly prone to outer ear infections. Their ear canals are smaller than adults,’ making it more difficult for fluid to properly drain out of the ear. This can lead to increased infections.
Ear pain is the most common symptom of an outer ear infection. Younger children or children who can’t speak may present with symptoms like:
- pulling on or tugging near their ear
- crying when touching their ear
- fever, in rare cases
- being fussy, crying more than usual, or having trouble sleeping
- fluid draining from the ear
Complications and emergencies
If an outer ear infection goes untreated and does not heal on its own, it can result in several complications.
Abscesses can develop around the affected area within the ear. These may heal on their own, or your doctor may need to drain them.
Long-term outer ear infections can cause narrowing of the ear canal. Narrowing can affect your hearing and, in extreme cases, cause deafness. It will need to be treated with antibiotics.
Ruptured or perforated eardrums can also be a complication of outer ear infections caused by items inserted into the ear. This can be extremely painful. Symptoms include temporary hearing loss, ringing or buzzing in the ears, discharge, and bleeding from the ear.
In rare cases, necrotizing (malignant) otitis externa occurs. This is an extremely serious complication where the infection spreads to the cartilage and bone that surrounds your ear canal. Adults with weakened immune systems are most at risk. Untreated, it can be fatal. This is considered a medical emergency, with symptoms including:
- severe ear pain and headaches, especially at night
- ongoing ear discharge
- facial nerve palsy, or drooping of the face on the side of the affected ear
- exposed bone in the ear canal
A doctor can usually diagnose an outer ear infection by assessing the patient’s symptoms and looking into the patient’s ear with an otoscope.
Outlook and prevention
The prognosis for these types of infections is usually quite good, as infections often heal on their own or are eliminated simply by taking eardrops.
The best way to prevent swimmer’s ear is to keep your ears as dry as possible. When you are swimming, using earplugs or a bathing cap can help.
After swimming or showering, it’s recommended that you dry your ears thoroughly.
Tilting your head so that each ear faces the ground helps empty out excess water. Keeping objects, like cotton swabs, hairpins, pens, or pencils, out of your ear will help prevent damage and lower your risk of infection.