Ear infection - outer

Symptoms of outer ear infection

Symptoms of an outer ear infection can include:

  • pain
  • itching
  • discharge from your ear
  • temporarily dulled hearing – if the swelling is enough to block your ear canal

If you have any of these symptoms, see your GP.

Complications of outer ear infection

Infections can spread across your skin (cellulitis) or form a large abscess.

Otitis externa can sometimes progress to a severe infection called malignant otitis. This is when the infection spreads into the bones surrounding your ear, which make up your skull. It can be life-threatening without treatment. If you have problems with your immune system or diabetes, you may be more likely to get malignant otitis.

If left untreated, an outer ear infection can cause deafness. This is because your ear canal can become narrowed or completely blocked.

Causes of outer ear infection

Outer ear infections are usually caused by bacteria or yeast (fungal infection). Anything that irritates the skin of your ear canal or causes an allergic reaction can also cause inflammation.

You’re more likely to develop an outer ear infection if you:

  • damage your ear canal – with a cotton bud, your fingernail, or any other object
  • use hearing aids or earplugs – these can irritate your ear canal or introduce bacteria
  • swim often – this can affect the amount of ear wax in your ear; too little allows bacteria to grow and too much causes water to become trapped, becoming an ideal environment for bacteria
  • swim in contaminated water – this may introduce bacteria
  • live in a hot, humid climate – the infection is then known as tropical ear
  • are sensitive to certain soaps, shampoos, hairsprays and hair dyes – these can irritate your ear canal
  • have a build-up of wax in your ear canal that causes discomfort and signs of infection
  • have a narrow ear canal, which means that water can become trapped and is susceptible to bacteria
  • have a skin condition, such as dermatitis or psoriasis – broken skin is more likely to become inflamed

Diagnosis of outer ear infection

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may look into your ear using an instrument called an otoscope to check for signs of swelling and infection. He or she may ask you to move your jaw to see if you feel pain.

If your symptoms don't improve after treatment or they reoccur, your GP may take a sample of the discharge from your ear using a swab. This will be sent to a laboratory for testing to find out whether your ear infection is caused by a bacterial or fungal infection.

If you have reoccurring outer ear infections that don’t respond to treatment, or you have suspected malignant otitis, your GP will refer you to an ear, nose and throat (ENT) specialist – a doctor specialising in conditions affecting the ear.

Treatment of outer ear infection

Treatment usually consists of controlling pain and treating the inflammation.

Medicines

The following medicines can help relieve and treat the symptoms of an outer ear infection.

  • Over-the-counter painkillers (eg paracetamol or ibuprofen) to relieve pain.
  • Acetic acid ear drops or spray to kill several types of bacteria. You can buy these over-the-counter. They are often used to treat mild infections.
  • Antibiotics to treat a bacterial or yeast infection. These are usually prescribed as ear drops but your GP may prescribe tablets if you have widespread infection or you’re at risk of having a severe infection.
  • Steroid-containing ear drops to help reduce swelling in your ear and any subsequent itching from eczema.
  • Aluminium acetate ear drops to help to reduce swelling in your ear.

Most ear drops will contain a combination of steroids, antibiotics and antifungals and some come in a spray rather than ear drops. You may need to have your ear cleaned and any discharge or wax removed by your doctor or nurse before using ear drops to treat an infection. You may be asked to lie down or tilt you head to the side with your affected ear facing upwards when you use ear drops. Sometimes, it’s advised to keep still for ten minutes after using ear drops or a spray.

It may be difficult to get ear drops into your ear if your ear is swollen, so your doctor or nurse may apply the treatment using an ear wick. An ear wick is ribbon gauze or a sponge wick, which is placed in your ear and absorbs the drops when they are applied. This allows the ear drops to stay in constant contact with the affected part of your ear. The ear wick is usually left in place for a couple of days, before your doctor or nurse removes it. The ear wick is usually fitted and removed in hospital.

Alternatively, your doctor or nurse may smear a small strip of gauze dressing with antibiotic ointment and gently place it in your ear canal. You may be shown how to remove the dressing yourself.

Prevention of outer ear infection

You can help to prevent an outer ear infection by taking steps to keep your ears clean and dry.

The following tips can help to reduce your risk of having an outer ear infection.

  • Don't lie with your head underwater in the bath.
  • Put cotton wool smeared with petroleum jelly in your ears before you wash your hair or have a shower.
  • Keep hairspray or shampoo away from your ears.
  • Dry your ears with a hair dryer (on the lowest heat setting) after washing your hair.
  • Don’t use cotton buds or other objects to clean your ear canal.
  • Never pick your ears with your fingernails.
  • Wash your hands before touching your ears.
  • If you regularly use ear plugs in your workplace, make sure you use a clean pair every day.
  • Use ear plugs when you go swimming.

I seem to get a lot of ear wax. How can I get rid of it?

Answer

You shouldn't try to remove ear wax yourself. Ear wax protects your ear and trying to remove it can damage your ear.

Explanation

Ear wax is produced by the glands near to your ear canal. It’s there to protect your ear and normally works its way out naturally. Occasionally, however, ear wax can block your ear and dull your hearing.

Using cotton buds or other objects to try to clean ear wax out of your ears can push it further inside and block your ear. Trying to remove ear wax yourself can also cause an ear infection, as you may damage the skin of your ear canal.

If you think you have a problem with ear wax, ask your GP for advice. Ear wax doesn't normally need to be removed unless it’s making your ear itch, or is affecting your hearing. Your GP may suggest using olive oil ear drops to soften the wax. You can buy these over-the-counter. If a plug of ear wax has formed, your GP may suggest you have your ear syringed. You may need to use olive oil ear drops for three to five days before having your ears syringed to make the ear wax easier to remove.

When your ears are syringed, lukewarm water is squirted into your ear canal to dislodge the plug of ear wax. Ear syringing itself carries a risk of ear infection and isn’t recommended as a treatment if your ear canal has been previously inflamed or damaged.

You can have ear wax removed by microsuction. This is usually done by a nurse or an ear, nose and throat (ENT) specialist – a doctor specialising in conditions affecting the ear. Under a microscope, a very small vacuum sucker is used to gently remove wax from your ear.

What treatment is given for malignant otitis?

Answer

Malignant otitis is treated with antibiotics. Surgery is sometimes needed to remove parts of the affected bone.

Explanation

Malignant otitis is a complication of an outer ear infection (otitis externa). This is when the infection spreads from your ear to the bones of your skull and eventually into the cerebrospinal fluid (the fluid that surrounds the brain and spine). It can be life-threatening without treatment.

You will need tests in hospital to confirm whether you have malignant otitis. These may include a CT scan or a biopsy. A CT scan uses X-rays to make a three-dimensional image of the body/or part of the body. A biopsy involves removing a sample of cells or tissue to confirm diagnosis.

Malignant otitis is usually treated with antibiotics. These will usually be given as ear drops, but if these don’t work, you may be given another type of antibiotic through a drip in your arm. Sometimes, surgery is needed to remove the infected bone and tissue or drain any fluid.

What is the best way to apply ear drops?

Answer

You will need to tilt your head to one side or lie down while you apply your ear drops. This is so the drops do not run out of your ear.

Explanation

Your GP or pharmacist will explain how to apply your ear drops. However, below is a general guide.

  • Lie down or tilt your head so that your infected ear is pointing upwards.
  • Pull your outer ear backwards and upwards (just backwards in children).
  • Drop the prescribed number of drops into the affected ear, and massage the area of skin that forms the entrance to your ear canal.
  • You may need to stay with your head tilted/lying down for a few minutes.
  • Return your head to an upright position and wipe away any excess drops with tissue.
  • Don't put cotton wool into your ears after applying ear drops, as it will absorb the drops and they won’t be as effective.
  • Ensure the drops are at room temperature.