Symptoms of an outer ear infection can include:
If you have any of these symptoms, see your GP.
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.
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:
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 usually consists of controlling pain and treating the inflammation.
The following medicines can help relieve and treat the symptoms of an outer ear infection.
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.
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.
You shouldn't try to remove ear wax yourself. Ear wax protects your ear and trying to remove it can damage your ear.
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.
Malignant otitis is treated with antibiotics. Surgery is sometimes needed to remove parts of the affected bone.
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.
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.
Your GP or pharmacist will explain how to apply your ear drops. However, below is a general guide.