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External Otitis

External Otitis (Swimmer’s Ear) means any type of infection of the outer ear canal. External otitis is different from infections caused by fluid behind the eardrum (otitis media). There are generally two types of external otitis:

  • Acute or infectious external otitis
  • Chronic external otitis

Acute external otitis is also known as “swimmer’s ear” because of its association with swimming in fresh waters. Acute external otitis is an infection by multiple types of bacteria and fungi. External otitis can occur in children or adults. If not treated, acute external otitis may spread to the cartilage and bone around the ear canal. The most common cause of acute external otitis is from instrumenting the ear, especially from cotton-tipped swabs! The skin of the ear canal is very thin and can easily be traumatized by even the end of a cotton-tip causing bacteria to invade the ear canal skin. 

Chronic external otitis is caused by irritation of the skin of the outer ear canal. Although it also may become infected by bacteria or fungi, chronic external otitis is primarily a problem of the skin. Chronic external otitis is associated with other skin disorders outside the ear such as eczema, dermatitis, or psoriasis. Treatment is usually with various types of corticosteroid creams. Dr. Pasha may also refer you to a Dermatologist (skin doctor) if you have persistent problems.

Chronic external otitis is caused by irritation of the skin of the outer ear canal. Although it also may become infected by bacteria or fungi, chronic external otitis is primarily a problem of the skin. Chronic external otitis is associated with other skin disorders outside the ear such as eczema, dermatitis, or psoriasis. Dr. Pasha may also refer you to a Dermatologist (skin doctor) if you have persistent problems.

FAQ about External Otitis

What are the signs of external otitis?

Acute external otitis usually causes ear pain that worsens when the earlobe or outside part of the ear is touched or moved. There may also be itching in the ear canal before the pain or as the ear canal recovers from the infection. As the infection worsens the ear may release a greenish-yellow discharge or pus from the ear. Hearing may also be affected especially as the ear canal swells.

Chronic external otitis causes itchiness or irritated ears that occur over a long time. The ear may become painful and may release pus if it also becomes infected.

How do you treat acute external otitis?

External otitis is typically cured within 7-10 days. Dr. Pasha may do any of the following depending on the severity of your infection:

  • Clean your ear canal in the office. If your infection causes a lot of debris and pus in your outer ear, Dr. Pasha may suction out the material to help fight the infection.
  • Prescription ear drops. Ear drops may contain antibiotics to fight the bacteria infection, steroids to control the inflammation, or a combination of the two. Typically drops may be placed 2-3 times per day for 5-10 days depending on the severity.
  • Place a wick in your ear canal. If your outer ear canal is too swollen, you may require a small sponge wick to be placed in order to allow the ear drops to reach your entire canal.
  • Prescription antibiotics. Rarely are antibiotics required for routine external otitis. You may be prescribed antibiotics if your symptoms persist or if the infection has spread outside the ear canal.
  • Pain medications. If your pain is severe, you may be prescribed a mild painkiller for 2-3 days as your infection improves
What about external otitis caused by fungi?

If Dr. Pasha suspects your ear canal is infected by a fungus, he may prescribe ear solutions that are specific for fungi. It is also especially important to keep your ear canal dry to prevent reoccurrence.

What causes acute external otitis?

There are several things one may do to avoid external otitis:

  • After swimming always attempt to get rid of water in your ear by pulling your ear in different directions or by using a hair dryer
  • Do not use cotton-tipped swabs (Q-tips™), bobby pins, or any other object in your ear. (Grandma’s saying, “never put anything in your ear smaller than your elbow” is true.)
  • Consider earplugs when swimming.
  • If you have frequent infections you may consider using a mixture of 1/3 sterile water, 1/3 isopropyl alcohol, and 1/3 white vinegar. Mix and keep in your refrigerator. Apply with a dropper to both ears after showering or swimming. (Obtain permission first by Dr. Pasha before using this solution. Do not use if you have a hole in your eardrum.)
  • If you are diabetic, make sure your sugars are well controlled.
How do you treat chronic external otitis?
  • Steroid Lotion or Cream. If you have chronic external otitis with itchiness you may be prescribed a lotion or cream that you may apply with a cotton-tipped applicator at night. The steroid typically takes a few days before resulting in improvement.
  • Avoid using cotton-tipped swabs or other instruments in your ear.
What should I watch out for?

Rarely does external otitis become serious. The most serious complications occur if the infection spreads to the outside of the ear or into the surrounding cartilage or bone. This complication occurs more frequently if one’s diabetes is out of control. When this occurs, your ear or side of your face may become red, swollen, or tender. One may also develop high fevers and become ill. Occasionally, the infection may affect the nerve of the side of your face causing facial weakness. If these symptoms occur you must call Dr. Pasha or report to the emergency room. You may require hospitalization and intravenous antibiotics.

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