Otitis Externa

What is otitis externa?

• Otitis externa is an infection in the outer ear canal. It is also called swimmer's ear. The outer ear canal begins inside the ear at the eardrum, and goes to the outside of the ear. The eardrum is a thin layer of tissue that divides the middle and outer ear canals.
  
  
• Otitis externa may be acute (short-term) or chronic (long-term). Otitis externa and its symptoms may go away with or without treatment. Treatment can decrease the infection and inflammation in your ear. If your ability to hear has decreased, your hearing may return to how it was before you had otitis externa. Treatment for otitis externa may help prevent other ear problems and serious infections.

What causes or increases my risk of getting otitis externa?

Otitis externa is an infection that is caused by germs called bacteria or fungi. The following may cause or increase your risk of getting otitis externa:

• Having an injury, such as a scratch, in your ear. Your outer ear canal may be injured by objects that are stuck into your ear, such as cotton swabs.
  
  
• Having an itchy rash (skin reaction) in your ear.
  
  
• Having a weak immune system. The immune system in your body works to prevent and fight infection.
  
  
• Having diabetes (a disease that causes high blood sugar).
  
  
• Having less ear wax than normal. If you enjoy swimming or if you live somewhere that is humid (moist) or hot, you are more likely to have water in your ears. Having water in the ear can decrease the amount of earwax that is normally found in the ear. Ear wax coats the outer ear canal, and helps prevent germs from getting into the skin.

What are the signs and symptoms of otitis externa?

With otitis externa, your outer ear will be red and swollen. You may have fluid leaking out of your ear. You may have ear pain. Your outer ear canal may have an itchy rash. You may feel a bump in your ear canal, called a polyp. Flakes of skin may fall from your ear. Your ear may feel plugged up. Your may not be able to hear as well as you could before getting the infection.

How is otitis externa diagnosed?

Your caregiver will ask how you long you have had your signs and symptoms. He may ask about your recent activities, such as swimming. Your caregiver will look for infection or other problems in your outer ear canal. He will look inside your ears and check if your eardrum is damaged. You may also need a hearing test. Ask your caregiver for more information about these and other tests that you may need.

How is otitis externa treated?

Your medicine may be in the form of eardrops, an ointment, or a powder, or it may need to be taken as a pill. Ask your caregiver for information about the medicines that you need to use.

• Antibiotic medicine: You may need to take antibiotic (germ-killing) medicine to help fight bacteria causing an infection in your ear.
  
  
• Anti-fungal medicine: This medicine may be needed if your otitis externa infection is caused by fungus.
  
  
• Over-the-counter medicine: Over-the-counter (OTC) medicines can be bought without an order (prescription) from a caregiver. OTC medicine may be used to decrease pain or fever (high body temperature). These medicines are safe for most people to use, and can help you feel better when used correctly. However, they can cause serious problems when they are not used correctly. People using some other medicines or that have certain medical conditions are at a higher risk for problems. Using too much, or using these medicines for longer than the label says can also cause problems. Follow directions on the label carefully. If you have questions, talk to your caregiver.
  
  
• Wicking: Your caregiver will remove fluid or wax from your outer ear canal. Caregivers may insert a small tube, called a wick, into your ear to help drain fluid. A wick also may be used to put medicine into your ear canal if the canal is blocked.

What are the risks of having and treating otitis externa?

• Antibiotic medicine may cause headaches, ear pain, or a rash in your outer ear canal. You may have burning pain in your ear if you need to take anti-fungal medicine. Your outer ear canal may grow stiff, or it may feel blocked. Even with treatment, you may get otitis externa more than once. Your hearing may not improve with treatment.
  
  
• If you need treatment and do not get it, you may get cellulitis, which a serious inflammation in your body tissue. The infection in your ear can spread to other parts of your head, including your brain. You may get a serious infection called meningitis. You may get a disease called necrotizing otitis externa, which can damage the skin and bones of your skull. This disease also may cause nerve damage in your face. Without treatment, these problems can worsen and become very serious. Ask your caregiver if you have questions or concerns about otitis externa, or its treatment.

How should I care for my ears?

• Wrap a clean moist washcloth around your finger, and use it to clean your outer ear and remove extra ear wax.
  
  
• Avoid swimming if you have otitis externa. If you choose to swim, use earplugs.
  
  
• Dry your outer ears completely after swimming or bathing. To dry your ears, tip your head to the side to help drain water from your ear canal. Wrap a dry washcloth around your finger, and gently dry your outer ear and ear canal. You may use a blow dryer (on the lowest heat setting) to dry your ears. When using the dryer, hold it at least 12 inches (one foot, or 30 centimeters) away from your head.
  
  
• Never put cotton swabs or other small objects inside your ear canal.

How do I use eardrops?

• Read the label on the bottle to learn how many drops need to be put in your ear. Ask your caregiver if you have questions about how much medicine to use, or when to use it.
  
  
• Wash your hands before using the medicine.
  
  
• Lie down on your side with your infected ear facing up.
  
  
• Carefully drip the correct number of eardrops into your ear.
  
  
• Gently move the outside part of your ear back and forth to help the medicine reach your ear canal.
  
  
• Stay lying down in the same position (with your ear facing up) for 3 to 5 minutes.

How do I put eardrops in my child's ear?

• Read the label on the bottle to learn how many drops need to be put in your child's ear. Note when and how often the medicine needs to be given. Ask caregivers to show you how to put drops in your child's ear before doing it the first time.
  
  
• Remove any fluid in your child's outer ear. You may do this by gently putting a twisted piece of cotton or a tissue in your child's ear. Throw the used cotton or tissue away in the trash.
  
  
• Wash your hands.
  
  
• Put one drop of medicine into your child's ear. Wait for a few seconds between putting each drop in your child's ear. This lets the medicine settle into your child's ear canal.
  
  
• After putting in the eardrops, press gently on your child's tragus. The tragus is the ear flap that is located closest to the top of the jaw.

Where can I find more information?

Contact the following:

• American Academy of Otolaryngology - Head and Neck Surgery
  1650 Diagonal Road
  Alexandria , VA 22314-2857
  Phone: 1- 703 - 836-4444
  Web Address: http://www.entnet.org
  

When should I call my caregiver?

Call your caregiver if:

• The skin around your outer ear looks red and feels warmer than usual.
  
  
• You feel a new bump inside your ear canal.
  
  
• You feel pressure in your ear.
  
  
• You have a fever.
  
  
• You have fluid leaking from your ear.
  
  
• You have new or more trouble hearing.
  
  
• Your signs and symptoms do not get better after two days of treatment.
  
  
• Your signs and symptoms go away for a time, but then come back.

When should I seek immediate care?

Seek care immediately or call 911 if:

• You suddenly are unable to hear at all.
  
  
• You have new swelling in your face, behind your ears, or in your neck.
  
  
• You have severe (very bad) pain in your ear.
  
  
• You suddenly cannot move part of your face.
  
  
• Your face suddenly feels numb (loses feeling).

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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