Otitis Externa

(Swimmer’s Ear)


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.

Risk Factors

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:


Your doctor will ask 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.
Talk with your doctor about the best treatment plan for you. Options may include:


If you have an infection, medication will depend on the cause of the infection. Other medications will help reduce other symptoms, such as pain and inflammation. Your doctor may recommend:
  • Oral nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
  • Antibiotic ear drops to treat any infection
  • Oral antifungal medications to treat fungal infections
  • Oral antibiotics to treat severe infections or cellulitis of the ear canal
  • Corticosteroid ear drops to reduce inflammation (this may be combined with an antibiotic ear drop)
  • Intravenous antibiotics for malignant otitis externa
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:
  • Infection that has spread to the base of the skull
  • Bone abscess
  • Failure of other treatment methods
Debridement, the removal of dead tissue, may also be necessary to help the healing process.

Other Suggestions

Your doctor may also recommend:
  • Keeping the ear dry for 7-10 days
  • Taking baths instead of showers
  • Avoiding swimming
  • Avoiding rubbing or scratching the ear or inside the ear canal
  • Avoiding using hearing aids or earplugs until you are healed


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

Health Canada


Block SL. Otitis externa: providing relief while avoiding complications. J Family Practice. 2005;54(8):669-676.

Otitis externa. EBSCO DynaMed website. Available at: Updated December 18, 2014. Accessed August 10, 2015.

Otitis externa (swimmer's ear). National Center for Emergency Medicine Informatics website. Available at: Accessed August 10, 2015.

Rutka J. Acute otitis externa: treatment perspectives. Ear Nose Throat J. 2004;83(9 Suppl 4):20-21;discussion 21-22.

Swimmer’s ear. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: Updated December 2010. Accessed August 10, 2015.

Swimmer’s ear (otitis externa). Centers for Disease Control and Prevention website. Available at: Updated March 11, 2015. Accessed August 10, 2015.

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