Otitis Externa: Infection of the Ear Canal

Otitis externa is a potentially serious ear inflammation that can usually be treated very successfully with topical antibiotics. Yet physicians in a recent study prescribed systemic antibiotics 65% of the time. Topical antibiotics treat the skin surface at the site of the infection (inside the ear in this case), while systemic antibiotics treat the entire body, usually via a pill taken by mouth.

Otitis externa (OE) is an inflammation of the ear canal between the ear drum and the outside of the ear. The ear canal can be easily infected because it is dark and warm and bacteria (germs) or fungus may grow there. The ear canal is the only skin-lined cul-de-sac in the human body, which contributes to foreign organisms growing there.

Otitis externa most often occurs when too much water gets in the ear such as after swimming or showering. It's easier for germs and fungus to grow when water removes the protective ear wax. Cleaning your ears can have the same effect. However, excessive ear wax can trap organisms in the ear canal and cause OE, as well. If you suspect that you have excessive ear wax, consult your physician.

An infection can also develop in the ear canal if you injure the skin there by putting your finger or some other object in your ear. Acne, psoriasis and other skin conditions that occur in other parts of the body can also occur in the ear canal and cause OE.

To prevent OE, it's important to keep the ear canal's natural defenses against infection working well. Leave ear wax in the canal. If ear wax appears to affect your hearing or hurt your ear, see your physician. Keep your ears as dry as possible. After swimming or showering, use a towel to dry your ears well. Turn your head to each side and pull the earlobe in different directions to help water run out. A hair dryer set on the lowest speed and heat can also help dry ears, but be sure to hold it several inches from your ear.

When surfing or swimming, use a tight-fitting bathing cap or wet suit hood to keep water out of your ears. However, do not wear ear plugs as they can irritate the ear canal. Hearing aids can also irritate the ear canal; hypoallergenic silicone hearing aids should be considered if OE is a recurring problem.

Symptoms and Treatment

If you have OE, your ear might itch, hurt, feel plugged up, or your hearing might be affected and the ear might drain. The pain might get worse when your ear moves while you're chewing. If any of these things happen, see your physician. One study showed that 36% of patients found otitis externa to be disabling enough to interrupt their daily activities. If you get treatment, these symptoms should go away.

Your doctor will examine the ear canal and remove any pus or drainage. Flushing of the ear, however, is not recommended because it may cause further damage, particularly if the ear drum cannot be fully observed beforehand. Suctioning is the preferred cleansing option. The ear drum will be examined for signs of other infection. A thorough examination of the head and neck should be performed to look for possible complications of OE and exclude other diagnoses.

While pills are sometimes necessary to treat otitis externa, most cases of OE can be treated with ear drops. Ear drop medications may contain substances to dry the ear, restore normal pH balance or reduce inflammation. Depending upon the problem, oral antibiotics may be used if a patient's temperature rises above 101 F (38.3 C), which may indicate the infection has spread or otitis media is present. (Otitis media is an infection of the middle ear between the ear drum and the inner ear.)

OE is uncommon in children younger than two years, but otitis media may occur in children under age two or if the patient has had an upper respiratory infection. In people whose immune system is compromised, such as those with diabetes, oral medication may be started early to treat OE.

Ear drops should be carefully put into the ear, not on the outside. Rub the bottle of ear drops in your hands to warm it up. Using warm ear drops may prevent you from becoming dizzy when the drops go in. To help the medicine go deep into the ear canal, gently move the earlobe back and forth after putting in the drops. When using ear drops, do not discontinue them until all your symptoms have been gone for three days (typically 5-7 days total).

While being treated for OE, keep your ear as dry as possible for seven to 10 days. Take baths instead of showers. When you wash your hair, try to keep water out of your ear. Don't swim or play other water sports. Ask your doctor when you can return to swimming. Don't put anything but the prescribed medicine in your ears. Scratching and rubbing your ear will only make it worse.

Symptoms are usually better within three days. They should be completely gone within 10 days. Call your doctor if you're not better by then. You may be referred to an otolaryngologist (an ear-nose-throat specialist).

For more information, see an article by the author below in the March 1, 2001, edition of American Family Physician's "Practical Therapeutics" (Vol. 63, No. 5).

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.