Outer ear infection or inflammation | Pokenga taringa

Overview
Clinicians
Clinicians

An outer ear infection (pokenga taringa) affects the outer opening of your ear and the tube that runs from the outer ear to the middle ear (the ear canal). It causes pain, itchiness and swelling, so is sometimes called itchy ear. It is also known as otitis externa or swimmer's ear.

Key points about outer ear pain and swelling

Outer ear infection or inflammation is also known as otitis externa or swimmer's ear. It is different to otitis media, which affects your middle ear.
It is often seen in swimmers or people whose ears are wet a lot of the time. Other causes include damage from cleaning, using earbuds or hearing aids, chemical irritation and infected hair follicles.
Symptoms can also be due to inflammation caused by an allergy or irritation.
People of all ages can be affected, but it most often occurs in adults aged 45–75 years.
Treatment options include keeping the infected ear dry and using ear drops.

What causes outer ear pain and swelling?

The most common cause of outer ear inflammation is an infection caused by bacteria, or less often, fungus. Your risk of getting an infection is increased if:

Your ears are often wet. Dampness creates an ideal environment for bacteria and fungi to grow and make your ears more prone to infection.
Skin damage. This could be from scratching, cleaning with cotton buds, or using ear buds, in-ear headphones or a hearing aid.
Use of chemicals. These are found in products such as shampoo, conditioners, hair spray and hair dye that can irritate your ears, making them more prone to infection.
Skin or allergic conditions. Such as dermatitis, psoriasis, eczema, acne, asthma or hay fever.
Narrow ear canals. This stops water draining away easily.
A health condition that affects your ability to fight infection. For example, diabetes or HIV or if you are undergoing certain treatments, such as chemotherapy.
Infection of a hair follicle in your ear canal. This can cause a pimple or boil.
Discharge from middle ear infections. Sometimes infections of the inner ear can produce a pussy discharge that gets stuck in the ear canal and this can cause an outer ear infection.

What are the symptoms of outer ear infection?

Often only one ear is affected. Symptoms affect your ear and surrounding area, including:

ear pain or pain when moving your ear or jaw
itchiness and irritation in or around the ear canal
swelling and redness of the ear canal and surrounding area
peeling skin inside and around the outside ear
fluid from your ear, often with a bad smell
hearing loss.

A very rare but dangerous complication is malignant otitis externa. This is the spread of infection to the bones of your ear canal and lower part of your skull. If you have an outer ear infection and experience strange symptoms, such as dizziness or muscular weakness in your face, seek immediate medical help.

How is an outer ear infection diagnosed?

Your doctor will ask you about your symptoms and examine your ear. If your symptoms keep returning, then a swab (using a sterile cotton wool bud) from your ear will be taken and sent to the laboratory for testing.

What is the treatment for outer ear pain and swelling?

Initially, your doctor will clean the affected ear and prescribe ear drops and recommend you follow simple self-care measures. Further treatment depends on the severity and cause of the infection or inflammation. For example, specific treatments for skin conditions such as dermatitis, psoriasis or eczema may be prescribed.

Self-care for outer ear pain and swelling

Try to keep the affected ear dry.
- Wear a shower cap while showering and avoid swimming until symptoms have fully cleared.
- If water gets into your ears, turn your head to the side and pull your earlobe in different directions to help the water drain out.
Gently clean any discharge from the outer ear with cotton wool. Do not insert cotton buds in your ear.
Remove anything from the ear that may cause irritation, such as earrings or hearing aids.
Take pain relief such as paracetamol or ibuprofen if necessary and according to medical advice.
If a boil is the cause, holding a warm cloth over the affected ear can provide relief.

Ear candles do not help outer ear infection and are not recommended for treatment as they may cause more injury to the ears.

Ear drops for outer ear pain and swelling

Outer ear infection can get better without ear drops, but this may take weeks. Ear drops can help speed up the healing process. Ear drops usually need to be used several times a day for about a week.

For the treatment of mild discomfort of your outer ear, usually caused by water in the ear, you can get ear drops from your pharmacy, such as Vosol^®. Other ear drops need to be prescribed by a doctor, such as:

eardrops that contain antibiotics to treat infection, for example, Soframycin^®
antibiotic eardrops combined with a steroid to reduce the inflammation (swelling) associated with the ear infection, for example, Ciproxin HC^®, Sofradex^®, Locacorten-Vioform^®and Kenacomb^®.

How can outer ear pain and swelling be prevented?

It's not always possible outer ear infection or inflammation, but there are things you can do to reduce your risk of developing the condition.

Dry your ears thoroughly with a towel to remove water, sweat or moisture. Use a hair dryer on low to gently dry the ear canal. Don’t use the corner of a towel.
Avoid damaging your ears by not putting anything inside your ear canal, including cotton wool buds.
If you swim regularly, use a swim cap that covers your ears or use earplugs (inserted gently to avoid damage) to help prevent water getting into your ears.
Give your ears a break from ear devices such as earplugs, hearing aids and in-ear headphones.
Treat and prevent other conditions that may be triggering otitis externa, such as allergies, dermatitis, psoriasis and eczema.

Learn more about outer ear pain and swelling

Otitis externa DermNet New Zealand, NZ, 2005

Reviewed by

Dr Angus Shao is an ear, nose and throat consultant at North Shore Hospital, Waitematā DHB, and in private practice. Angus returned to Auckland in 2017 to provide specialist service as a fellowship-trained rhinologist and rhinoplastic surgeon. He has a broad interest in general ENT and paediatric ENT. He also specialises in surgery for nasal and paranasal disease, chronic sinusitis and rhinitis, and functional and cosmetic rhinoplasty. Angus is fluent in Mandarin and is interested in improving Asian health in Auckland.

References

Swimmer's ear Better Health Channel, Australia, 2014
Otitis externa Patient Info, UK, 2016

Credits: Health Navigator Editorial Team . Reviewed By: Dr Angus Shao, ENT specialist, Auckland Last reviewed: 17 Dec 2019 Page last updated: 20 Aug 2022

Information for healthcare providers on ear infection (outer ear)

The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.

Management of otitis externa

The following advice is from the Antibiotics guide – otitis externa BPAC, NZ, 2017:

First-line management is gentle cleansing of the external ear canal, e.g. with suction, a wick or probe. If signs of infection persist after thorough cleansing, a solution containing an anti-infective and a corticosteroid may be considered. Underlying chronic otitis media should be excluded before treatment.
Most topical antibacterials are contraindicated in the presence of a perforated drum or grommets; they may, however, be used with caution if cleansing of the ear canal alone has been unsuccessful in resolving symptoms.
Antibiotic treatment (topical) should only be considered if secondary infection is present.
Patients with acute infection should be advised to avoid immersing their ears while swimming or to wear a protective cap.

The following advice is from the Auckland HealthPathways, NZ, 2018:

If any red flags, especially if patient has diabetes or is immunocompromised, consider malignant otitis externa with progression to skull base osteomyelitis and request acute ENT/Otolaryngology assessment.
Treat with ear drops depending on the severity and suspected cause of the otitis externa, although studies have not shown any difference between the different types of ear drops. Eardrop options include topical acidifying agents, glucocorticoids, antibiotics, antifungals, and combination treatment.
Explain how to use the ear drops properly:

Mild otitis externa 2% acetic acid drops (Vosol) or 2% acetic acid mixed with 1% hydrocortisone. Apply 5 drops three times a day until symptoms resolve. Review after 1 week.
Moderate to severe bacterial otitis externa Use an antibiotic and steroid drop such as Sofradex (about $11), 5 drops three times a day. Aim to fill the ear canal each time. Use for 3 to a maximum 5 days after symptoms resolve. Review after one week. More severe infections may need review by the ear nurse. If initial drops fail, seek ENT/Otorlaryngology advice or ear nurse advice.
Moderate to severe fungal otitis externa Locorten Vioform 5 drops four times a day for 5 to 7 days. Review after 1 week. Be aware that this ear drop can stain hair, clothes and bed linen. Cleaning the ear canal is very important in fungal infection. If there is a lot of debris that is difficult to remove, the patient may require referral to the ear nurse for cleaning.

If there is also a perforation of the tympanic membrane present secondary to acute otitis media, it is still advisable to use ear drops such as Sofradex to treat the otitis externa, but be aware of the small risk of damage to the inner ear.
Give systemic analgesia if needed.
Advise the patient to keep the ear canal dry for at least 14 days by avoiding water sports and wearing earplugs or a shower cap in the shower.
If the patient is febrile, systemically unwell, or cellulitis is present, consider oral antibiotics and request acute ENT/Otolaryngology assessment.
If recurrent otitis externa causing significant morbidity, or chronic otitis externa is not responding to recommended treatment, request non-acute paediatric ENT/Otolaryngology assessment (patient aged ≤ 15) or non-acute ENT/Otolaryngology assessment.
If the patient is prone to repeat infections, advise them about prevention of recurrence.

Continuing professional development

Common ENT infections – Bruce Arroll (21 minutes)
(PHARMAC, 2019)

For more videos of the same series, visit PHARMAC seminars.

Regional HealthPathways NZ

Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: