Outer ear infection: Overview – InformedHealth.org

Last Update: February 13, 2020; Next update: 2023.

Introduction

Outer ear infections typically lead to redness and swelling in the ear. They are among the most common causes of earache. In many cases they are caused by bacteria. But fungi, viruses or allergies are sometimes to blame too.

The outer ear includes the part of the ear you can see (the auricle) and the outer ear canal. The outer ear canal leads from the eardrum to the auricle. The medical term for inflammations of the outer ear is “otitis externa.” They are usually caused by infections.

Outer ear infection

Symptoms

Outer ear infections are often very painful– especially when you touch or tug on your earlobe. Itching is common too.

The skin in the ear canal is red and swollen, and sometimes also sheds skin flakes or oozes a liquid. The ear might then become blocked, making it difficult to hear properly.

In about 1 out of 3 people the symptoms are so severe that it affects their everyday lives. About 1 out of 5 people have to stay home from work or school for a few days because of the infection.

Causes and risk factors

Outer ear infections are usually caused by bacteria. They are sometimes caused by a fungus, such as a yeast, but that’s less common. Viral illnesses like the flu or a certain type of shingles (Zoster oticus) may also lead to an outer ear infection. And sometimes allergic reactions – for instance, to a shampoo – are to blame.

Outer ear infections are also often called “swimmer’s ear” because germs can easily get into the ear canal while you’re swimming. This means that people who swim a lot are more likely to get outer ear infections.

Minor injuries to the ear – for instance, through the use of cotton ear buds to clean your ear, or regularly wearing headphones that you stick inside your ear (“in-ear headphones”) – can increase the risk too. People who have already had an outer ear infection or are generally prone to infections are also more likely to get outer ear infections.

Prevalence and outlook

Outer ear infections are especially common in adults: About 1 out of 10 people will have one at some point in their life.

The infection is usually mild and clears up on its own after a few days or weeks. But it sometimes lasts longer. In rare cases it may spread to nearby tissue.

Prevention

In order to prevent outer ear infections, it’s important not to irritate or damage the ear canal. Pointed objects should never be inserted into the ear canal.

But simply trying to clean your ears with cotton ear buds can cause damage to the ear canal too. There’s no need to use cotton ear buds anyway because your ears clean themselves by producing earwax. When the earwax comes out of your ears, you can remove it (and the dirt inside it) with a tissue. If larger amounts build up or a hard “plug” develops, the earwax can be softened, for instance with olive oil, allowing it to leave the ear more easily.

It’s important to take care, though. If you are unsure, it might be better to get a doctor to flush out your ear and suck out the built-up earwax or carefully remove it with a thin, hook-like instrument.

The following things can also help to prevent outer ear infections:

• A snug-fitting swimming cap helps to keep water from entering the ear while swimming, showering or having a bath.

• People who use earplugs while swimming should make sure that they are soft and fit properly.

• If water does get into your ear, you usually just need to tilt your head to the side to let the water flow out. Gently pulling your earlobe and jumping up and down a little can help. You can also carefully dry your ear using a hairdryer at a low setting.

• If you often have problems with earwax buildup, it’s a good idea to have your ear cleaned by a doctor before going on any trips where you might do a lot of swimming.

• If you have sensitive ear canals, don’t use earplugs to protect your ears from noise, dust or water too often. That’s also true for the use of in-ear headphones when you listen to music or make phone calls. It might be better to try different headphones if you’re prone to outer ear infections.

If you’ve noticed that certain shampoos, soaps or other cosmetic products lead to ear infections, it’s best to try out other products instead.

Treatment

The medications that are commonly used to treat outer ear infections include painkillers and disinfectant ear drops or sprays. These are available from pharmacies without a prescription. Acute outer ear infections that are caused by bacteria are often treated using special ear drops that have to be prescribed by a doctor. If the symptoms don’t improve within a few days, it’s advisable to see a doctor.

If the infection is severe or lasts for several weeks, your doctor might clean your ear and place a little sponge or a strip of gauze soaked in ear drop fluid into your ear canal. Sometimes other kinds of medication are needed too – for instance, if the ear infection was caused by shingles.

Sources

• Burton MJ, Singer M, Rosenfeld RM. Extracts from The Cochrane Library: Interventions for acute otitis externa. Otolaryngol Head Neck Surg 2010; 143(1): 8-11. [PubMed: 20620612]

• Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Ohrenschmerzen (S2k-Leitlinie). AWMF-Registernr.: 053-009. 11.2014.

• Hajioff D, MacKeith S. Otitis externa. BMJ Clin Evid 2015: pii: 0510.

• Kaushik V, Malik T, Saeed SR. Interventions for acute otitis externa. Cochrane Database Syst Rev 2010; (1): CD004740. [PubMed: 20091565]

• Lenarz T, Boenninghaus HG. Hals-Nasen-Ohren-Heilkunde. Berlin: Springer; 2012.

• Wiegand S, Berner R, Schneider A, Lundershausen E, Dietz A. Otitis Externa. Dtsch Arztebl Int 2019; 116(13): 224-234. [PMC free article: PMC6522672] [PubMed: 31064650]

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6 Outer Ear Pain Causes

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Swimmer’s ear (otitis externa)

Swimmer’s ear, or otitis externa, is an infection of the canal which runs from the eardrum to the opening of the ear.

It is caused by anything that introduces bacteria, fungus, or a virus into the canal. Water that stays inside the ear after swimming is a common cause, as are cotton swabs used for cleaning or earpieces that create irritation.

Most susceptible are children, because they have narrower ear canals that do not drain well.

Early symptoms include redness, itching, and discomfort inside the ear canal, sometimes with drainage of clear fluid.

Even mild symptoms should be treated because they can quickly get worse. The infection can spread and intensify, becoming very painful with increased drainage, swelling, fever, and loss of hearing.

Diagnosis is made through patient history and physical examination of the ear canal. Lab tests may be done on a sample of the discharge from the ear.

Treatment includes having a medical provider clean the ear canal of debris and discharge, and a prescription for antibiotic and/or steroid eardrops.

Rarity: Common

Top Symptoms: fever, ear canal pain, ear fullness/pressure, jaw pain, ear pain that gets worse when moving

Urgency: Primary care doctor

Relapsing polychondritis

Relapsing polychondritis is an episodic, inflammatory and destructive disorder involving primarily cartilage of the ear and nose. It can also potentially affect the eyes, tracheobronchial tree, heart valves, kidneys, joints, skin, and blood vessels.

You should visit your primary care physician for mild severity of relapsing polychondritis. Medications such as NSAIDs and steroids are generally prescribed.

Obstruction

An ear foreign body is anything that gets stuck in the ear canal other than earwax. This may include food, toy pieces, beads, buttons, disk batteries, cotton swab, paper, or insects. Foreign bodies are usually trapped in the outer ear canal.

You should visit your primary care physician within the next 24 hours to have the foreign object removed. This is not a medical emergency requiring a visit to the ER, but the procedure should be performed by a medical professional to avoid damage to the eardrum. It is important to remove the object in a timely manner, however, to prevent discomfort and the possibility of an infection.

Mild frostnip of the ears

Frostnip is damage of the outermost layers of the skin caused by exposure to the cold (at or below 32F or 0C). It is most commonly found in people doing leisurely activities like camping, hunting, or snow sports.

Those with suspected frostnip should have wet clothing removed. Rubbing affected areas worsens damage to the tissue. You should go to an urgent care. If rewarming can occur without chance of refreezing, it can be tried in the field. At urgent care, the doctors will guide you in gently re-warming the wounded area in 98-102F (37C-39C) water. Further, ibuprofen, antibiotics, and a tetanus shot may be necessary

Rarity: Rare

Top Symptoms: ear numbness, outer ear pain, ear redness, turning blue or purple from coldness, cold ears

Symptoms that always occur with mild frostnip of the ears: cold ears

Urgency: In-person visit

Mild frostbite of the ears

Frostbite is tissue damage caused by exposure to the cold (at or below 32F or 0C). It is most commonly found in people doing leisurely activities like camping, hunting, or snow sports. It is also more likely in those who are intoxicated or have a mental disorder.

Those with suspected frostbite should have wet clothing removed. Rubbing affected areas worsens damage to the tissue. You should go to the ER by car, immediately. If rewarming can occur without chance of refreezing, it can be tried in the field. There, the doctors will guide you in gently re-warming the wounded area in 98-102F (37C-39C) water. Further, ibuprofen, antibiotics, a tetanus shot, and possibly surgery will be done to treat the pain and dead tissue. IV fluids will also be started. Hydrotherapy will be done daily to help with the wounded area.

Rarity: Rare

Top Symptoms: swollen ear, ear numbness, outer ear pain, ear redness, turning blue or purple from coldness

Symptoms that always occur with mild frostbite of the ears: cold ears

Urgency: Hospital emergency room

Lymph node inflammation behind the ear

There are lymph nodes behind the ear. Lymph nodes are where your immune cells live, and when they become enlarged, it could be from a nearby infection, immune response, or even backlog of blood.

You should see your primary care doctor tomorrow for a sick visit. There, the doctor can look at what could explain the enlarged node behind your ear.

Eczema (atopic dermatitis)

Atopic dermatitis, also called eczema, dermatitis, atopic eczema, or AD, is a chronic skin condition with an itchy rash.

AD is not contagious. It is caused by a genetic condition that affects the skin’s ability to protect itself from bacteria and allergens.

AD is most often seen in infants and young children. Most susceptible are those with a family history of AD, asthma, or hay fever.

Infants will have a dry, scaly, itchy rash on the scalp, forehead, and cheeks. Older children will have the rash in the creases of elbows, knees, and buttocks.

Without treatment, a child may have trouble sleeping due to the intense itching. Constant scratching may cause skin infections and the skin may turn thickened and leathery.

Diagnosis is made through physical examination, patient history, and allergen skin tests.

AD cannot be cured, but can be controlled through prescribed medications, skin care, stress management, and treatment of food allergies. Those with AD often have allergies to milk, nuts, and shellfish. Keeping the skin clean and moisturized helps prevent flareups.

Cellulitis

Cellulitis is a bacterial infection of the deep layers of the skin. It can appear anywhere on the body but is most common on the feet, lower legs, and face.

The condition can develop if Staphylococcus bacteria enter broken skin through a cut, scrape, or existing skin infection such as impetigo or eczema.

Most susceptible are those with a weakened immune system, as from corticosteroids or chemotherapy, or with impaired circulation from diabetes or any vascular disease.

Symptoms arise somewhat gradually and include sore, reddened skin.

If not treated, the infection can become severe, form pus, and destroy the tissue around it. In rare cases, the infection can cause blood poisoning or meningitis.

Symptoms of severe pain, fever, cold sweats, and fast heartbeat should be seen immediately by a medical provider.

Diagnosis is made through physical examination.

Treatment consists of antibiotics, keeping the wound clean, and sometimes surgery to remove any dead tissue. Cellulitis often recurs, so it is important to treat any underlying conditions and improve the immune system with rest and good nutrition.

Rarity: Uncommon

Top Symptoms: fever, chills, facial redness, swollen face, face pain

Symptoms that always occur with cellulitis: facial redness, area of skin redness

Urgency: Primary care doctor

Questions your doctor may ask about outer ear pain

• Is there anything coming from your ear(s)?
• Any fever today or during the last week?
• Do you use a hearing aid or wear earplugs?
• Do you often come into contact with hot tubs, swimming pools, or other sources of standing water?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

Doctor73 – News – Otitis externa. What to do if your ear hurts?

– During the period of temperature fluctuations, diseases of the ENT organs are extremely common. Inflammation of the mucous membrane of the nose and throat, so common with respiratory viral infections, can cause otitis externa. Valery Lisin, chief freelance specialist otolaryngologist of the Ministry of Health of the Ulyanovsk Region, head of the otolaryngological department of the Ulyanovsk Regional Clinical Hospital, spoke about how otitis externa manifests itself, what are its causes and what recommendations should be followed in the treatment of this insidious disease.

– What is otitis externa?

– Otitis externa is the general name for a group of diseases characterized by inflammatory changes in the structures of the auricle, external auditory canal. The disease is quite common, in most cases it is acute, but it can turn into a chronic form.

– How can it be caused?

– There are many causes of otitis externa. It develops as a result of water entering the ear and hypothermia, as a complication of acute respiratory viral infections, influenza, measles and other infectious diseases, as well as ear injury or infection with a fungus.

– What are the symptoms of otitis externa?

– The main symptom of otitis media is pain. It can be sharp, aching, pulsating. May fade and reappear. Alertness should cause discharge from the ear, especially with an admixture of pus and blood. Another symptom is a different kind of hearing loss. With otitis externa, unpleasant sensations, itching, swelling, and noises similar to splashing water may appear in the ear. If you do not hear the whisper of a person who is at a distance of 5-6 meters from you, the cause may be otitis externa.

– How to deal with these symptoms?

– Seek medical attention immediately. Untimely treatment can lead to the appearance of pus, scars. With abscessing boils of the external auditory canal, surgical intervention may be required. The occurrence of purulent processes in the ear requires the use of antibiotic therapy, both systemic and local.

– Diagnosis based on examination?

– In most cases, a visual examination is not enough to make a diagnosis. The doctor may prescribe laboratory and microbiological studies, as well as radiation and magnetic resonance imaging methods. In no case should you neglect the doctor’s prescriptions. For successful treatment, it is necessary to identify the cause of otitis externa.

– What are the preventive measures for otitis externa?

– First of all, this is the timely treatment of infectious diseases of the nasopharynx. It is necessary to treat not only inflammatory processes of the nose and throat, but also diseases of the oral cavity in a timely manner, and regularly undergo preventive examinations. Before swimming in ponds or pools, wear a rubber cap and try to keep water out of your ear. Quit smoking and drinking alcoholic beverages. During the course of antibiotic therapy, alcohol is strictly contraindicated. To avoid injury to the eardrum and outer ear, avoid using ear swabs and ear candles. It is enough to rinse the auricle with clean water, and after washing, gently blot with a towel. If the eardrum is damaged, it is impossible to wash the ear – if water enters, an inflammatory process may develop. Ear drops when the membrane is ruptured are also contraindicated.

Otitis externa – causes, symptoms, treatment

What is otitis externa?

This is an inflammation of the tissues of the external auditory canal, eardrum and auricle. Otitis externa is widespread. It is considered acute if it lasts less than 4 weeks, chronic if it lasts longer and/or recurs more than 4 times a year.

IMPORTANT! Information from the article cannot be used for self-diagnosis and self-treatment! Only a doctor can prescribe the necessary examinations, establish a diagnosis and draw up a treatment plan for a consultation!

Symptoms of otitis externa

There are three degrees of severity of otitis externa.

• Mild otitis externa: itching in the ear canal, redness inside the ear, unpleasant sensations in the ear, which are aggravated by pressing on the auricle or tragus (a small protrusion in the center of the auricle). A little clear, odorless liquid may come out of the ear.
• Moderate otitis externa: itching becomes worse, the ear hurts, there is obvious redness inside, the discharge increases, pus may appear. The auditory canal is felt as if filled as a result of edema and retention of the discharge.
• Diffuse (diffuse) otitis externa: severe pain in the ear, radiating to the neck, temple, cheek; the auditory canal is completely blocked; the auricle becomes red and swollen, as are the lymph nodes in the neck. The temperature is elevated, sometimes significantly.

When to go to the doctor?

See a doctor even if you have mild otitis externa. If you have severe pain and a fever, you should call an ambulance or go to the hospital immediately.

Causes of otitis externa

• water that enters the ear while swimming is a breeding ground for bacteria;
• picking in the ears with fingers, cleaning them with cotton swabs. As a result, a person damages the thin surface of the skin of the ear canal, which makes it vulnerable to infections;
• eczema, seborrhea, neurodermatitis, local skin irritation (from insect bites, etc.), allergy to earrings or hair products – may cause non-infectious external otitis media.

Otitis externa risks

• The habit of cleaning the ears with cotton swabs, sticks, fingers.
• Frequent swimming, especially in natural waters where the water is not purified.
• Narrow ear canal, eg in children.
• Wearing headphones, hearing aids.

Possible complications of otitis externa

As a rule, otitis externa does not cause complications and is easily treated. However, if complications do occur, they can be as follows:

• temporary hearing loss in the affected ear. Passes after recovery from otitis media;
• chronic otitis externa. It usually occurs when there are difficulties with the treatment of otitis externa, for example, with fungal and mixed bacterial-fungal forms;
• spread of infection to deep tissues – cellulitis of the neck, lymphadenitis, osteomyelitis. Similar complications (malignant otitis media) can occur in patients with immunodeficiency conditions, diabetes, and those receiving chemotherapy. Such complications can be life-threatening.

How to prevent otitis externa?

• Gently dab your ear after bathing, but don’t wipe the ear canal with anything.
• If water gets in your ear, you can shake it out by jumping on one leg and tilting your head to the same side. You can also dry the water in your ear with a hair dryer, setting it to the lowest setting and holding it about 30-40 cm from your ear.
• If you know that your eardrum has been damaged or punctured, you can use ear drops that will prevent bacteria from growing in your ear after water gets in.
• Do not swim in dirty water.
• Do not get into the ear canal with your finger, stick, cotton swab or swab – in a word, nothing.
• Protect your ears when using hairspray if you know it can irritate the skin inside the ear canal;
• If you have had ear surgery or ear infections, visit an ENT before swimming.

Diagnosis of otitis externa

Usually it is not difficult. Otitis externa is easily identified by its symptoms and the appearance of the ear and ear canal. The doctor may examine your ear with an otoscope. If he wants to make sure that the eardrum is not damaged, he can use a curette to clean the ear and take a deeper look.

If otitis media is diffuse, the doctor may need additional diagnostics of the condition of the middle ear, determination of the nature of otitis media (bacterial or otherwise), etc.

Treatment of otitis externa

the passage to clear itself, as it happens normally.

• Cleaning and irrigation of the ear canal. As a rule, the doctor cleans it with a curette to free it from particles of skin, stuck earwax and dried discharge (serous or purulent). This is necessary so that the ear drops can spill to the entire depth of the ear canal.
• Ear drops prescribed by an ENT or general practitioner (GP). Usually these are drops with antibiotics and / or corticosteroids. For severe pain, analgesics may be used.
• In case of severe swelling of the external auditory canal, the doctor may first replace the drops with turunda soaked in medicine. When the edema subsides, it is easy to remove the turunda from the ear, and you can continue to be treated with drops.
• When applying cold drops, hold them in the palm of your hand for a while to reduce discomfort. After the drops are in your ear, lie down for a few minutes on your healthy side so that the drops are better absorbed. You can ask someone to administer the drops for you – it’s more convenient.