Otitis Externa (External Ear Infection)
Inflammation or infection of the skin in the outer ear canal, often causing pain, itching, or discharge
Medically reviewed by a board-certified ENT specialist
- Author:
- Dr. Poj Pinyopornpanish — Otolaryngologist · Thai Board of Otolaryngology
- Medical reviewer:
- Dr. Poj Pinyopornpanish — Otolaryngologist · Thai Board of Otolaryngology
- Reviewed on:
- Last updated:
- Estimated reading time: 5 min
Overview
What is otitis externa?
Otitis externa is inflammation of the skin lining the outer ear canal, from the entrance to the eardrum. It is commonly caused by bacterial or fungal infection, or by irritation of the canal skin. It affects both children and adults and is often called “swimmer’s ear” when linked to water exposure. Symptoms range from mild discomfort to significant pain and discharge. Clinical assessment helps confirm the diagnosis and distinguish it from other causes, such as wax impaction or middle ear infection.
Symptoms
Common symptoms
Symptoms vary with severity and cause. Itching or mild discomfort may appear before more noticeable pain.
Ear pain, especially when pulling the ear or pressing the area in front of it
Itching in the ear canal
A feeling of fullness or blockage
Temporary muffled hearing in the affected ear
Discharge or fluid from the ear
Red or swollen skin in the canal
An unpleasant smell from the ear (in some cases)
Fever (less common, depending on severity)
Causes
What causes otitis externa?
Inflammation usually results from infection or irritation of the canal skin.
Bacterial infection
Certain bacteria can enter the canal and cause inflammation, especially when the skin is damaged or moist.
Fungal infection
Fungal otitis externa occurs in some cases, particularly with immune risk factors or prolonged ear drop use.
Irritation or allergy
Ear drops, sprays, or materials contacting the canal may trigger inflammation.
Water exposure
Trapped moisture after swimming or bathing can soften canal skin and increase infection risk.
Canal injury
Cotton buds and similar objects can injure canal skin and make infection more likely.
Skin conditions
Conditions such as eczema affecting the ear canal may increase the risk of recurrent inflammation.
When to seek care
When should I see an ENT specialist?
Seek assessment if symptoms persist, worsen, or warning signs are present.
Severe or worsening ear pain despite self-care
High fever or declining overall condition
Ear discharge, bleeding, or an unpleasant smell
Clear or persistent hearing reduction
Significant swelling or redness around the ear
Recurrent episodes
Diabetes, immune suppression, or other relevant medical conditions
Dizziness or balance symptoms that are concerning
Diagnosis
How is it diagnosed?
Your doctor will ask about symptoms, water exposure, ear drop use, and any objects placed in the ear. The ear is examined with an otoscope to assess canal inflammation, discharge, wax, and eardrum appearance. This helps distinguish otitis externa from middle ear infection and other causes. Swab testing or further assessment may be considered when appropriate.
Treatment
Treatment options
Treatment depends on cause, severity, and canal condition. The most suitable plan is chosen after clinical assessment.
Ear drops
Prescribed drops may include anti-inflammatory or antimicrobial components. Use as directed and follow proper instillation technique.
Canal cleaning
Wax or debris may be cleared before starting drops so medication can reach the canal effectively.
Oral medication
May be considered for more severe infection or spread beyond the canal, based on clinical findings.
Avoiding triggers
Water avoidance and stopping objects in the ear are often recommended until symptoms improve.
Self-care
What you can do at home
Focus on reducing irritation and watching for signs that need review.
Do not insert cotton buds, hairpins, or other objects into the ear canal
Avoid getting water in the ear until your doctor advises otherwise
Use prescribed ear drops correctly and consistently
Avoid unprescribed ear drops or remedies
Use pain relief as directed if there are no contraindications
Return for review if symptoms persist or worsen
Prevention
Reducing the risk of otitis externa
Not every case can be prevented, but certain habits may help lower risk.
Keep ears dry after water exposure by tilting the head and drying the outer ear
Avoid putting objects in the ear canal
Use ear protection for swimming when advised and fitted appropriately
Manage eczema or other canal skin conditions as directed
Seek review for recurrent episodes to identify triggers
FAQ
Frequently asked questions
Common questions about otitis externa symptoms, care, and when to seek help.
How is otitis externa different from a middle ear infection?
Otitis externa affects the outer canal skin and often hurts when the ear is pulled. Middle ear infection occurs behind the eardrum and is commonly linked to colds or Eustachian tube problems. Examination helps tell them apart.
Is ear pain after swimming always serious?
It may be early otitis externa. Mild symptoms that settle may be managed with appropriate care, but significant pain, fever, or discharge warrants medical assessment.
Can I use ear drops on my own?
Unprescribed drops are not recommended, especially if eardrum integrity is uncertain. Inappropriate drops may worsen symptoms.
How long does otitis externa take to improve?
Recovery time varies. Many people improve within several days of appropriate treatment, but you should follow medical advice through the full course.
Is otitis externa contagious?
It is not typically spread person to person like a cold. Shared earphones or devices should be avoided if there is active discharge.
References
Related guidelines and patient resources
The sources below are recognized international guidelines and patient-education resources for general learning. They are not individualized medical advice.
Patient information on ear and hearing conditions
AAO-HNS / ENThealth
View source (AAO-HNS / ENThealth)Patient education and clinical guidance in otolaryngology
American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS)
View source (American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS))Public ENT health information
ENThealth (AAO-HNS Foundation)
View source (ENThealth (AAO-HNS Foundation))
Educational information
Medical Disclaimer
This information is intended for educational purposes only and does not replace diagnosis or treatment by a qualified physician. If you have concerning symptoms, please consult an ENT specialist.
Related links
Learn more
Related clinic pages to help you explore conditions, services, and procedures.
Ear pain, itching, or discharge?
An assessment can confirm otitis externa or another cause and guide appropriate care for you.