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Otitis Externa / Swimmer's Ear Infection Causes, Symptoms, Diagnosis and Treatment

Otitis Externa / Swimmer's Ear Infection

Last Updated on Jun 02, 2021
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What is Otitis Externa?

Otitis externa, also commonly referred as Swimmer’s Ear, is an inflammatory condition that affects the external ear canal, which is the passage that connects the eardrum to the outer visible ear. The condition is often simply known as swimmer’s ear because it is in fact rather common among swimmers; frequent exposure to water in swimmers does make the canal more vulnerable to infections and inflammation.

Causes of Otitis Externa

Otitis externa can have various possible causes. It can be misleading to refer to it solely as swimmer’s ear infection, as it isn’t always caused by infection. Here are some of the common causes of otitis externa:

  • The condition is often caused by infection with the Pseudomonas aeruginosa or Staphylococcus aureus bacteria.
  • At times seborrhoeic dermatitis, which commonly affects the scalp and areas of skin that are oily, can also cause irritation and inflammation in the ear canal.
  • Otitis externa could at times actually be caused by otitis media or a middle ear inflammation. If an infection of the middle ear is present the discharge from within may affect the external ear canal.
  • Fungal infections are another very common cause for infections in the outer ear, which may be caused by fungi from the Candida albicans or Aspergillus groups.
  • The condition may occur as an allergic response or simply due to irritation from contact with ear plugs of a particular material, a new shampoo or even sweat. At times, ear drops being used to remove wax could also be responsible for the irritation.
  • Incomplete or improper treatment for otitis externa can result in frequent recurrences.

Symptoms of Otitis Externa

Otitis externa usually begins with mild symptoms that progressively worsen if not treated. Early symptoms of otitis externa include:

  • Itchiness in the ear canal
  • Visible redness in the ear
  • Discomfort when you touch or apply any pressure on the ear
  • Odorless and clear discharge from the ear, which may sometimes be foul-smelling and consist of pus

The intensity of pain, itching and discomfort increases if the condition is allowed to progress, and the entire ear will appear to be inflamed and red. Fluid discharge from the ear may become bothersome. Hearing is also often affected. Sounds may be muffled and you will most likely experience a sensation of pressure and fullness in the ear.

If treatment is delayed or not followed appropriately, the condition can become severe and you may notice symptoms that include:

  • Severe pain that radiates to the face and neck
  • Visible swelling and inflammation of the outer ear
  • Swelling of the lymph nodes
  • Fever
Symptoms of Otitis Externa

Diagnosis of Otitis Externa

The primary method of diagnosis of otitis externa is through a physical examination. This can cause some discomfort as almost any movement of or contact with the outer ear would cause some pain. This is an important part of the physical examination however, as it will enable your physician to arrive at a diagnosis. An otoscope will be used to examine the eardrum, but this may not be possible because of swelling of the ear canal and because of the presence of discharge and debris.

Culture of the discharge may be sent to a lab for analysis. This could help identify the fungus or one of the bacteria that is responsible.

Treatment for Otitis Externa

Otitis externa may resolve without treatment at times, but it could take weeks and there is a risk that it may instead worsen. Treatment for otitis externa is usually quite effective and if followed properly the condition should resolve within just a few days.

  • Antibiotic for Otitis Externa – The most commonly used and most effective method of treatment is with antibiotic eardrops. There are several brands of eardrops and if the condition does not respond as desired, your doctor will change the prescription or try different combinations. Combination treatments of antibiotics with steroidal sprays have also been found to be effective when treating acute otitis externa.
  • Painkillers for Otitis Externa – If the ear pain is severe and is a constant source of discomfort your doctor will also prescribe painkillers.
  • If there is severe inflammation and blockage, your doctor may have to drain and clean the ear of any debris or discharge. In some cases a method involving gentle suctioning or syringing may be used to get rid of the discharge.
  • If the infection is severe and swelling and inflammation have even affected the skin of the ear, it may be difficult to administer ear drops as they may not reach the end of the ear canal. In such cases, oral antibiotics may also be prescribed.
Treatment of Otitis Externa

Complications of Otitis Externa

There is little risk of complications developing from otitis externa but in rare cases the condition may cause the formation of abscesses in and around the ear. Your doctor may need to drain these pus-filled pockets. Chronic otitis externa could cause a narrowing of the ear canal because of the buildup of thick and dry skin over a period of time. If neglected, it interferes with hearing and could even cause deafness. If treated early, the problem can be resolved easily.

In some cases, the infection could spread to the eardrum. The eardrum may rupture because of the excessive pressure on it, resulting in hearing loss, discharge, pain and tinnitus. Cellulitis, which is a bacterial skin infection, may also develop because of otitis externa. The skin becomes tender, red and painful, but it is something that can be effectively treated with antibiotics.

Malignant Otitis Externa

Malignant otitis externa is a serious condition in which the infection also spreads to the bone of the ear canal, but it is fortunately rare. It is more common in adults, especially among those with weakened immunity as in the case of patients suffering from health conditions like HIV, diabetes, or those undergoing chemotherapy. The condition is not only painful but it may even leave bone exposed in the ear canal. If not treated, this complication can be fatal. However, antibiotics and surgical methods of treatment are extremely effective and the condition can be cured.


  1. Swimmer's ear - (http://www.nlm.nih.gov/medlineplus/ency/article/000622.htm)
  2. “Swimmer’s Ear” (Otitis Externa) - (http://www.cdc.gov/healthywater/hygiene/disease/swimmers_ear.html)
  3. Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA, Huang WW, Haskell HW, Robertson PJ. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. 2014 Feb;150(1 Suppl):S1-S24. doi: 10.1177/0194599813517083. Review. Erratum in: Otolaryngol Head Neck Surg. 2014 Mar;150(3):504. PubMed PMID: 24491310.
  4. van Balen FA, Smit WM, Zuithoff NP, Verheij TJ. Clinical efficacy of three common treatments in acute otitis externa in primary care: randomised controlled trial. BMJ. 2003 Nov 22;327(7425):1201-5. PubMed PMID: 14630756; PubMed Central PMCID: PMC274056.

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