Outer Ear Infections

External otitis is a condition that occurs when the ear canal becomes inflamed. The ear canal is the part of the ear that leads from to the ear drum (figure 1). External otitis can develop as a result of an infection, allergy, or skin problem. “Swimmer’s ear” is the name for external otitis that occurs in a person who swims frequently. External otitis is different from otitis media (middle ear infections).

What causes an outer ear infection?

An outer ear infection happens when the skin in the ear canal gets irritated or scratched, and then gets infected. This can happen when a person:

  • Puts cotton swabs, fingers, or other things inside the ear
  • Cleans the ear canal to remove ear wax. Ear wax serves to protect the ears from water, bacteria, and injury. Excessive cleaning or scratching can injure the skin, potentially leading to infection. Bacteria, which normally live in the ear canal, can then enter the skin more easily.
  • Swims on a regular basis – Water can soften the ear canal, which allows germs to infect the skin more easily. 
  • Wears hearing aids, headphones, or ear plugs. These items can damage the skin and trap moisture in the ear canal and can worsen an infected ear.

(Figure 1)

External Otitis Symptoms

The most common symptoms of external otitis include:

  • Pain in the outer ear, especially when the ear is pulled or moved
  • Itchiness or wet feeling of the ear
  • Fluid or pus leaking from the ear
  • Difficulty hearing

Is there a test for an outer ear infection?

No. There is no test. But your doctor should be able to tell if you have it by learning about your symptoms and looking in your ear. During the visit, your doctor might clean out your ear so that it can heal more quickly.

How is an outer ear infection treated?

  1. Ear Drops – Ear drops kill germs and reduce pain and swelling. Be sure to finish all the medicine, even if you feel better after a few days. 
    • Lie on your side or tilt your head so gravity helps the drops get into the ear canal.
    • Pull your outer ear back, this straightens the ear canal, improving the delivery of the medication. Place the ear drops in the ear canal.
    • “Pump” the ear canal a few times by pressing on the tragus (small cartilage in the front of the ear) to disperse the drops.
    • Stay in the same position for several minutes (after the ear drops are in). This allows the medicine to stay in contact with the infected area.
  2. Pain Medication – If you have bothersome ear pain, you can take a non-prescription pain medication.
  3. Keep you ear dry – During treatment, you should avoid getting the inside of your ears wet. It is important to keep the inside of your ear dry while the infection heals and avoid swimming for several weeks after an infection or until your doctor indicates.  Typically, we recommend that “dry ear precautions” become a normal part of your routine.  It is common for these infections to re-occur because of moisture getting into the ear.
    • While showering, you can place a cotton ball coated with petroleum jelly or another ointment in the ear. Do not push the cotton ball into the ear canal.
    • You should also avoid wearing hearing aids or headphones in the infected ear until your symptoms improve. These tend to trap in moisture.
    • Use a hair dryer to evaporate moisture from your ear. Pull the outer ear back to straighten the canal, turn a hair dryer on low, place it 5-10 inches from the skin, and let it blow in the ear canal for several minutes daily.
  4. Your physician may recommend the following:
    • Irrigate your ear canal liberally with a 1:1 mixture of rubbing alcohol and white vinegar. This can be done twice daily for active infections or every other day for maintenance.  Use a generous amount enough to fill the canal.  Let is sit for a few minutes then shake out the excess. Rubbing alcohol, isopropyl alcohol, is an antiseptic and evaporates quickly helping to removing water from the ear canals.  Vinegar, consists of 5–20% acetic acid.  The acidity makes it difficult for the harmful organisms to grow.  The volume of the liquid also mechanically helps flush out debris from the ear canal.  If you are using a medicated drop in addition, use the drop 30 minutes after any irrigation.  If this is painful stop and discuss with your physician.
    • Irrigate your ear canal liberally with hydrogen peroxide. Pull your ear back, tip your head over, or place a towel on your shoulder, and liberally flush out the ear canal.  Irrigate with a bulb, syringe, or medicine bottle that allows you to “squirt” the fluid into the ear canal.  Then “pump” the ear for 30-60 seconds to agitate the fluid and break up the wax.  Repeat the irrigation to flush out any wax or debris that was loosened up. The flush, pump, flush helps flush out wax or debris through the mechanical action.  Peroxide is also an antiseptic. If you are using a medicated drop in addition, use the drop 30 minutes after any irrigation.  If this is painful stop and discuss with your physician.

You should begin to feel better within 36 to 48 hours of starting treatment. If your pain worsens or does not improve within this time period, call your healthcare provider.

External Otitis Prevention

The ear is self-cleaning; fingers, towels, cotton-tipped applicators, and other devices should not be used to clean the inside of the ears.

If you feel that you need to clean excessive wax (cerumen) from your ears, talk to your healthcare provider first. Ear wax protects the ear canal.  It may be necessary to keep your ears dry for several months. If you swim frequently, experts recommend the following tips to reduce the chance of developing external otitis.

  • Consider wearing ear plugs made for swimming.
  • Use OTC ear drops or the alcohol/vinegar solution after swimming to prevent ear infections
  • Blow dry your ears on a low setting, holding the dryer 12 inches away.