Otitis externa

Symptoms of otitis externa 

Symptoms of otitis externa include:

• ear pain, which can be severe
• itchiness in the ear canal
• a discharge of liquid or pus from the ear
• some degree of temporary hearing loss

Usually only one ear is affected. With treatment, these symptoms should clear up within a few days.

Long-term symptoms 

In some cases, the symptoms of otitis externa can persist for several months, or sometimes years. This is known as chronic otitis externa.

Symptoms of chronic otitis externa can include:

• a constant itch in and around your ear canal
• discomfort and pain in your ear that becomes worse when you move it – this is usually much milder than in short-term otitis externa
• a thin, watery discharge from your ear
• a lack of earwax
• a build-up of thick, dry skin in your ear canal, known as stenosis, which can narrow your ear canal and affect your hearing

When to see your GP 

You should see your GP if you think you have otitis externa.

Your GP will ask about your symptoms. They will also ask if you regularly use any items that are inserted into your ears, such as hearing aids or ear plugs.

They may also examine inside your ear using an instrument called an otoscope.

If you have otitis externa often and it has not got better with treatment, your GP may take a swab of the inside of your ear.

This will be tested to help find out if you have an infection. If you have an infection, the best medication can then be prescribed.

Causes of otitis externa  

Most cases of otitis externa are caused by a bacterial infection. The condition can also be caused by:

• irritation/dermatitis
• fungal infections
• allergies

There are a number of things that can make you more likely to develop otitis externa, including:

• damaging the skin inside your ear
• regularly getting water in your ear
• chemicals - hairspray, hair dyes, ear drops
• skin conditions — such as atopic dermatitis, seborrhoeic dermatitis, psoriasis, and acne

Getting water in your ear is particularly significant, because this can cause you to scratch inside your ear and the moisture also provides an ideal environment for bacteria to grow.

Who is affected

Otitis externa is quite common. It's estimated that around one in 10 people will be affected by it at some point in their lives.

The condition is slightly more common in women than men. It is most often diagnosed in adults aged 45 to 75.

People with certain long-term (chronic) conditions are at greater risk of developing the condition. These include:

• eczema and asthma
• allergic rhinitis
• diabetes or any condition causing reduced immune response to infection

How otitis externa is treated 

Otitis externa sometimes gets better without treatment, but it can take several weeks. Your GP may prescribe medication, such as ear drops, depending on the cause. Medication usually improves the symptoms within a few days.

Your GP may refer you to a specialist for further treatment and advice if symptoms are severe or they fail to respond to treatment.

Preventing otitis externa 

To help reduce your chances of developing otitis externa, you should avoid inserting cotton wool buds and other things into your ears (including your fingers). Inserting these into your ears can damage the sensitive skin in your ear canal.

If you're a regular swimmer, consider using ear plugs when swimming or wearing a swimming cap to cover your ears and protect them from water.

You should also try to avoid getting water, soap or shampoo into your ears when you have a shower or bath.

Complications 

Complications of otitis externa are uncommon, but some can be very serious.

One rare complication of otitis externa is malignant otitis externa. This is when an infection spreads from the ear canal into the surrounding bone.

This requires prompt treatment with antibiotics and sometimes surgery, as it can be fatal if left untreated.

• Find out more about ear infections on the NHS website

More useful links

• How to use your health services
• Middle ear infection (otitis media)