Outer ear infection

An outer ear infection, also known as otitis externa, is an inflammation of the external ear canal that can be caused by a variety of factors. This condition affects both adults and children and is particularly common during the summer months, when many people spend more time in the water. Outer ear infection is often referred to as ‘swimmer’s ear’, as it frequently occurs following prolonged contact with water. In this comprehensive guide, you will learn everything about the causes, symptoms, diagnosis and treatment of this painful condition.

What exactly is an outer ear infection?

An outer ear infection is an infection or inflammation of the external auditory canal, which extends from the outer ear to the eardrum. This condition is painful and can significantly affect daily life. The risk of developing an outer ear infection increases if the ear canal remains damp, for example after swimming or showering. However, the condition can also be caused by mechanical irritation, such as inserting foreign objects or cotton buds into the ear canal.

An outer ear infection differs from a middle ear infection, which affects the middle ear and is more common in young children. Whilst middle ear infections are triggered by colds and upper respiratory tract infections, otitis externa is often caused by external factors.

• Bacterial infections: The majority of outer ear infections are caused by bacteria, particularly Pseudomonas aeruginosa and Staphylococcus aureus. These bacteria can enter the ear canal, especially if the natural protective layer of the ear canal skin is weakened. This often happens when the ear canal is damp, for example after swimming.

• Fungal infections: In some cases, otitis externa can be caused by fungi, particularly in tropical or humid climates. Fungal infections of the ear canal are less common, but can be particularly persistent and require prolonged treatment.
  
  
• Injuries to the skin of the ear canal: Inserting foreign objects, such as cotton buds or hairpins, into the ear canal can injure the skin and lead to inflammation. These micro-injuries provide an ideal breeding ground for bacteria and fungi to multiply and cause an infection.
  
  
• Skin conditions: Certain skin conditions, such as eczema or psoriasis, can make the skin of the ear canal more susceptible to infection. These conditions irritate and inflame the skin in the ear canal, increasing the risk of an outer ear infection.
  
  
• Earwax and irritants: Earwax plays an important role in protecting the ear canal by keeping out dirt and bacteria. However, excessive or improper removal of earwax can damage the natural protective layer of the skin in the ear canal and cause inflammation. Furthermore, chemical irritants such as certain shampoos or hair dyes can irritate the ear canal and trigger otitis externa.

Recognising the symptoms of otitis externa

The symptoms of otitis externa can vary greatly depending on the severity of the inflammation and the underlying cause. The most common signs of an outer ear infection include:

• Earache: Earache is the most common symptom of an outer ear infection. The pain can range from mild to very severe and is often made worse by touching or moving the ear. The pain may also radiate to the jaw or neck and be particularly intense when chewing.
  
  
• Itching in the ear canal: Persistent itching in the ear canal is a common early symptom of an outer ear infection. Scratching can make the inflammation worse and should be avoided.
  
  
• Discharge from the ear: In cases of severe inflammation, there may be a yellowish or greenish discharge from the ear. This discharge usually consists of pus and indicates a bacterial infection.
  
  
• Feeling of blockage in the ear: Many sufferers report a feeling of pressure or a sensation that the ear is blocked. This can be caused by swelling in the ear canal or by the build-up of pus.
  
  
• Temporary hearing loss: If the ear canal is severely inflamed or blocked by pus, this can lead to temporary hearing loss. This usually disappears once the inflammation has been treated.
  
  
• Swelling and redness of the ear: In some cases, the outer ear, including the auricle, may be swollen and red. This is a sign that the inflammation has spread to the surrounding tissue.

Diagnosis of an outer ear infection

An outer ear infection is usually diagnosed through a clinical examination. The doctor will examine the ear using an otoscope, a special instrument that allows them to view the ear canal and the eardrum. During the examination, the doctor can determine whether the ear canal is swollen or inflamed and whether there is any pus or other fluid present.

In some cases, the doctor may take a sample of the discharge to identify the specific bacteria or fungi that caused the infection. This is particularly important if the infection does not respond to standard treatment or is recurrent

Treatment options for outer ear infections

Treatment for an outer ear infection depends on the severity of the inflammation and the underlying cause. In most cases, a combination of medication and self-care is recommended.

• Medication: The most common treatment for a bacterial outer ear infection is antibiotic ear drops. These drops are administered directly into the ear canal to combat the bacteria and relieve the inflammation. Antibiotics are particularly effective against bacterial infections and are often prescribed alongside corticosteroid-containing drops to reduce swelling and itching.
  For fungal infections, antifungal ear drops are used. These may be used for several weeks to ensure that the fungal infection clears up completely.
  
  
• Pain management: Painkillers such as ibuprofen or paracetamol can be taken to relieve pain. These medicines also help to reduce inflammation and improve general well-being.
  
  
• Cleaning the ear canal: In some cases, it may be necessary to have the ear canal professionally cleaned by a doctor, particularly if pus, dead skin cells or excess earwax have built up. This can be done by gently suctioning or flushing the ear canal.
  
  
• Avoiding water in the ear: During treatment, it is important to keep the ear dry to prevent the inflammation from worsening. This can be achieved by wearing earplugs when showering or bathing.

Preventive measures against outer ear infections

Preventing otitis externa is particularly important to avoid recurrent infections. Here are some tips on how to reduce the risk of an outer ear infection:

• Keep your ears dry: After swimming or bathing, make sure your ears are completely dry. Tilt your head to one side to allow water to drain from the ear canal, and use a soft towel to gently dry the ear. Carefully removing excess earwax can also help reduce the risk of inflammation.
  
  
• Do not insert foreign objects into the ear canal: Avoid inserting cotton buds, fingers or other objects into the ear canal. These can damage the delicate skin of the ear canal and cause an infection.
  
  
• Protection when swimming: If you swim frequently, you should consider using special earplugs to prevent water from entering the ear canal. These are available from pharmacies and can significantly reduce the risk of otitis externa.
  
  
• Treat skin conditions: If you suffer from skin conditions such as eczema or psoriasis, you should treat them specifically to minimise the risk of otitis externa. Your doctor can prescribe special creams or ointments that protect and care for the skin in the ear canal.
  
  
• Take care when using hearing aids and headphones: Hearing aids and in-ear headphones can increase the risk of an outer ear infection if they are not cleaned regularly. Make sure to keep your devices clean and disinfect them regularly to prevent infections.

Long-term consequences and complications of an outer ear infection

Although most cases of otitis externa respond well to treatment and resolve without long-term consequences, complications can arise in some cases, particularly if the condition is not treated properly.

Chronic otitis externa

An untreated or inadequately treated outer ear infection can become chronic. In this case, recurrent inflammation occurs, which can impair hearing and lead to permanent damage to the ear canal.

Perichondritis

In severe cases, the inflammation can spread to the ear cartilage and the outer ear, causing a condition known as perichondritis. This condition is difficult to treat and can lead to permanent deformities of the ear.

Spread of the infection

In rare cases, the infection can spread to the surrounding tissue or even to the middle ear, which can lead to otitis media or mastoiditis. These complications require more intensive treatment and can have serious consequences.

When should you see a doctor?

It is important to take the symptoms of otitis externa seriously and to see a doctor if necessary. You should seek medical help if:

• The pain does not subside or worsens despite the use of painkillers.
• You notice a sudden or persistent loss of hearing.
• You develop a fever, which could indicate a more serious infection.
• There is a pus-like or bloody discharge from the ear

Seeing a doctor early on can help prevent complications and speed up recovery.