What Is It?

Otitis externa is an infection of the ear canal caused by bacteria or fungi. It often is called swimmer’s ear because it is associated with frequent swimming. Prolonged exposure to water, which may contain certain bacteria, makes the skin of the ear canal swollen and more susceptible to infections. Summer humidity also changes the skin of the ear canal, increasing the possibility of infection.

While otitis externa is most common in the summer, it can occur year round. People with skin conditions such as eczema and seborrhea may be more prone to infections. Others who may be more susceptible to swimmer’s ear include people who:

• Suffer trauma to the ear canal, usually when trying to clean the ear with a cotton swab or other instrument
• Have small ear canals that do not drain adequately on their own
• Experience drainage of pus from chronic, middle-ear infections with perforation of the eardrum

Frequent use of earplugs, hairsprays, and frequent showers and/or shampooing all have been associated with otitis externa.

Symptoms of otitis externa include:

• Itching of the ear canal
• Redness of the skin of the outer ear or ear canal
• Drainage from the ear canal, often yellow or green or possibly cheesy
• Pain, when touching the ear or moving the jaw while chewing or talking
• Decreased hearing

Otitis externa usually is diagnosed by examination of the ear with a special viewing tool called an otoscope. The examiner looks for:

• Swelling or redness of the skin of the external ear canal
• Draining fluid or debris in external ear canal
• Tender lymph nodes near the ear

In rare cases, a culture of the drainage is necessary. Your health-care provider also may examine the eardrum to look for signs of middle-ear infection.

With treatment, symptoms usually improve within one to three days and go away completely in seven to 10 days. The problem can recur, especially if steps are not taken to prevent repeatedly getting water in the ear canals.

To help prevent swimmer’s ear:

• Keep your ear canal dry. Limit your time exposed to water.
• To keep water out of your ears while showering, use a ball of cotton covered with a layer of petroleum jelly.
• If you get water in your ears, dry them thoroughly. First, turn your head to the side and pull the earlobe in different directions to help the water run out. Gently dry the opening to the ear canal. Then use a hair dryer briefly on its lowest setting held at arm’s length to dry the rest of the canal.
• Do not use cotton swabs to clean your ears because they can cause trauma to ear canals, making them more susceptible to infection. In addition, swabs usually push wax deeper into the ear canal, and water can get trapped behind wax buildup.
• Do not use earplugs unless they are designed specifically to keep water out because water gets trapped behind most earplugs. They also tend to push wax back into your ear canal.
• Make your own preventive eardrops by mixing equal parts white vinegar and rubbing (isopropyl) alcohol. The vinegar restores the natural acidity of the ear canal, making it less susceptible to infection while the alcohol dries out the ear. Use three to four drops in each ear after swimming.

Swimmer’s ear usually is treated with prescription eardrops. The most commonly used drops combine medications to fight the infection (polymyxin and neomycin), and calm the inflammation (hydrocortisone). Drops usually are placed in the ear canal three or four times per day for about five days. Follow the instructions on your prescription.

In people who are allergic to neomycin, the use of these drops may cause the sudden onset of redness and swelling of the ear canal. The reaction may extend to the outer ear and surrounding skin and may be accompanied by blisters. If you experience such a reaction, discontinue the use of the eardrops and contact your health-care provider immediately.

In severe cases of otitis externa, swelling may make it difficult for the medicated drops to get down into the ear canal. In these cases, your health-care provider may place a wick in the ear canal to help the eardrops travel deeper into the canal.

The treatment of otitis externa usually requires prescription medication. Call your health-care provider if you or your child has symptoms suggestive of this condition.

With treatment, symptoms usually improve within 24 hours and go away in two or three days. If you currently are being treated for otitis externa, call your health-care provider for follow-up if:

• The symptoms worsen
• Fever develops
• New symptoms develop
• The symptoms are not beginning to go away in two to three days

Some people, particularly those who have diabetes or other immune-system problems, can develop a severe form of this condition known as malignant otitis externa that requires immediate hospitalization for treatment with intravenous antibiotics. If you have diabetes, AIDS or another condition that makes you more susceptible to infections, contact your health-care provider immediately if you develop symptoms of otitis externa.

Uncomplicated cases of swimmer’s ear should go away within five days with appropriate treatment. Muffled hearing should return to normal as the swelling subsides.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.