Otitis Externa

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What are the symptoms of otitis externa?

Symptoms include itch, ear discharge, temporary dulled hearing, and pain.

What causes otitis externa?

Otitis externa is common and often occurs 'out of the blue' for no apparent reason.

Some people seem prone to otitis externa. If you get water, shampoo, soap, hair spray, etc, in an ear, it may cause it to itch. You may then scratch or poke the ear. This can damage the skin in the ear canal, and cause inflammation. Inflamed skin can quickly become infected. A vicious circle may then develop. The inflammation and infection cause more itch, you then scratch more, which makes things worse, etc.

Other possible causes of otitis externa include:

• Swimming. Otitis externa is five times more common in regular swimmers compared to non-swimmers. It is due to the water which gets into the ear canal. In fact, otitis externa is sometimes called 'swimmers ear'.
• Weather. Otitis externa is more likely to develop in hot, humid, and 'sweaty' weather. It is more common in hot countries.
• Skin problems. Eczema or psoriasis may affect the ear canal and cause an otitis externa.
• Ear syringing to clear ear wax. This may irritate the ear canal and cause inflammation.

What is the treatment for otitis externa?

Ear drops or sprays
A doctor or nurse will usually prescribe a short course of ear drops or an ear spray. These usually contain an antibiotic to clear any infection, and a steroid to reduce the inflammation and itch. It may take a week or so of treatment for symptoms to go completely. There are several brands of drops or sprays used to treat otitis externa. If one does not work well then a doctor or nurse may advise changing to another brand with different ingredients.

When you use ear drops:

• Lie with the affected ear upwards.
• Put several drops in the ear, and lie in this position for 1-2 minutes.
• Press the cartilage at the front of the ear canal a few times to push the drops deep inside the ear canal.

Antibiotic tablets or medicines
These are sometimes needed if the infection is severe, particularly if infection spreads from the ear to nearby skin or other tissues.

General measures
As a rule, do not leave balls of cotton wool in the ear canal. This stops the discharge (debris) which needs to come out. However, if the discharge is heavy, you may need to place some cotton wool lightly in the outer part of the canal to mop up the discharge. If you use cotton wool, replace it frequently with a fresh piece. Do not try and clean the ear canal with cotton buds. If you stick buds or other objects into your ear they may damage and irritate the inflamed skin, and make things worse. Just clean the outside of the ear with a cloth when any discharge appears.

Painkillers
Paracetamol or ibuprofen will usually ease any pain. Stronger painkillers are occassionally needed. If you hold a hot flannel against the ear it may also ease pain.

Further treatment
Other treatment may be needed if the inflammation is more severe, or if the above measures do not work within a week or so.

• A doctor or nurse may clean the ear canal. They do this by using cotton wool on the end of a special stick which is gently pushed inside the ear canal to mop up any discharge or debris. Sometimes gentle suction or syringing is used. This removes the discharge lying in the ear canal.
• Sometimes a gauze 'wick' is soaked in ear drops and is pushed into the ear canal. This gets the drops right to the end of the ear canal, particularly if it is very swollen.
• A doctor may also take a swab (specimen of the discharge) to find out which germ is causing the infection. This helps to guide the choice of antibiotic ear drops to use. (Some germs are resistant to some types of antibiotic.)

How can I prevent further bouts of otitis externa?

If you are prone to otitis externa, to help prevent recurrences you should keep your ears dry and leave them alone! This means:

• Try not to let soap or shampoo get into your ear canal. You can do this when you have a shower by placing a piece of cotton wool coated in soft white paraffin (eg Vaseline) into the outer ear.
• Do not use corners of towels or cotton buds to dry any water that does get in the ear canal. This will push things further in. Let the ear dry naturally.
• Try not to scratch or poke the ear canal with fingers, cotton wool buds, towels, etc.
• Do not clean the ear canal with cotton buds. They may scratch and irritate, and push wax or dirt further into the ear. The ear cleans itself, and bits of wax will fall out now and then.
• When you swim try to keep your ears dry. You can do this by wearing a tightly fitting cap that covers the ears. Some swimmers use silicone rubber earplugs, but only use them if they do not irritate the skin in your ear canal.

© EMIS and PIP 2006   Updated: June 2006   PRODIGY Validated