Otitis Externa (Swimmer's Ear): Symptoms, Causes and Treatment
Does your ear hurt, particularly when you touch or pull the outer ear? Are you also experiencing itching, a blocked sensation or discharge from the ear? These may be symptoms of otitis externa.
Otitis externa is inflammation of the skin lining the external ear canal. It is frequently caused by infection and is particularly common during the summer months, especially after swimming. For this reason, it is often called swimmer's ear.
Although usually straightforward to treat, otitis externa can become extremely painful without appropriate care.
What causes otitis externa?
The external ear canal is lined with delicate skin, naturally protected by earwax (cerumen).
When this protective barrier is disrupted, inflammation and infection can develop more easily.
Common contributing factors include:
Water and moisture: Swimming, frequent water exposure or water remaining in the ear canal.
Cotton buds: These can cause tiny injuries to the skin of the ear canal and remove its natural protective layer.
Skin conditions: Such as eczema or psoriasis.
Hearing aids and earplugs: These may irritate the ear canal or affect its ventilation.
Acute otitis externa is most commonly caused by bacteria, although fungal infections can also occur.
What are the symptoms of otitis externa?
Typical symptoms include:
Ear pain, often made worse by pulling the outer ear or pressing the tragus (the small cartilage in front of the ear canal).
Itching or irritation inside the ear.
A blocked or full sensation.
Watery or purulent ear discharge.
Temporary hearing reduction due to swelling or debris blocking the ear canal.
The pain can sometimes be severe enough to make chewing or sleeping on the affected side uncomfortable.
Importantly, otitis externa is different from a middle-ear infection (otitis media). Although both conditions can cause earache, their treatment may differ considerably.
Bacterial or fungal ear infection?
Bacterial otitis externa commonly causes significant pain, swelling and discharge.
In contrast, fungal otitis externa (otomycosis) often presents with persistent itching, a blocked sensation and characteristic fungal debris within the ear canal.
However, the symptoms can overlap, and a careful examination is important to distinguish between these conditions and choose the appropriate treatment.
How is otitis externa treated?
Treatment depends on the underlying cause and the severity of the inflammation.
For most uncomplicated bacterial infections, antibiotic ear drops, often combined with a topical corticosteroid, are effective.
Fungal infections may require antifungal treatment.
When discharge, dead skin or debris accumulates within the ear canal, careful cleaning under microscopic guidance using a fine suction instrument (microsuction) can help the medication reach the affected skin and support recovery.
If the ear canal is significantly swollen, a small medicated wick may occasionally be inserted to help deliver the treatment.
Oral antibiotics are generally unnecessary for uncomplicated otitis externa. They may be required if the infection spreads beyond the ear canal or in selected higher-risk patients.
Importantly, some ear drops may be unsafe if the eardrum is perforated or a ventilation tube (grommet) is present. An appropriate preparation should therefore be selected following clinical assessment.
What can you do at home?
The following measures can support recovery:
Keep the affected ear dry and avoid swimming until the infection has resolved.
Do not insert cotton buds or other objects into the ear canal.
Use suitable pain relief, such as paracetamol or ibuprofen, if appropriate for you.
Apply prescribed ear drops exactly as directed.
Avoid putting homemade remedies or unidentified liquids into the ear.
When should you seek urgent medical attention?
Seek prompt medical assessment if ear pain becomes increasingly severe or is accompanied by fever, swelling around the ear or general deterioration.
Particular caution is needed in patients with diabetes or a weakened immune system. Although uncommon, a serious infection known as necrotising otitis externa can develop and spread to surrounding tissues and bone.
Severe ear pain, particularly at night, or new facial weakness requires urgent assessment.
If symptoms fail to improve within 48–72 hours of starting treatment, a further medical review is recommended.
Most cases of otitis externa respond well to appropriate treatment. Accurate diagnosis, careful ear canal cleaning when necessary and correctly selected topical medication are key to successful recovery.
References
Rosenfeld RM et al. Clinical Practice Guideline: Acute Otitis Externa. Otolaryngology–Head and Neck Surgery. 2014. DOI: 10.1177/0194599813517083
NHS Inform. Outer ear infection (otitis externa). Patient information
NHS Greater Glasgow and Clyde. Otitis externa – ENT referral guidance. Clinical guidance
