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Outer Ear Infection (Otitis Externa)

What is otitis externa?

Otitis externa, also called outer ear infection or swimmer’s ear is an inflammation of the ear canal. The ear canal is between the ear drum and the outer visible ear.

Otitis externa can develop as a result of an infection (bacterial or fungal), allergy, or skin problem. “Swimmer’s ear” is the name for otitis externa that occurs in a person who swims frequently.

Otitis externa is different from otitis media (middle ear infections).

What are the risk factors for an outer ear infection?

Several factors increase the risk of developing otitis externa:

  • Excessive cleaning or scratching the ear can injure the skin of the ear canal, potentially leading to infections.
  • Swimming on a regular basis removes some of the ear wax, allowing water to soften the skin. Bacteria, which normally live in the ear canal, can then enter the skin more easily.
  • Wearing devices that block the ear canals, such as hearing aids, headphones, or ear plugs, can increase the risk of otitis externa (if worn frequently) by injuring the skin.
  • Allergic skin conditions can lead to otitis externa (eg, from earrings or chemicals in cosmetics or shampoos).
  • Skin problems like psoriasis, eczema or dermatitis.
What are the symptoms of outer ear infection?

The most common complaints are:

  • Ear pain, worse on touching or moving the ear.
  • Itchiness of the ear
  • Fluid or pus leaking from the ear
  • Difficulty hearing clearly
How is outer ear infection diagnosed?

Diagnosis of otitis externa is majorly clinical based on the history you give the doctor and the physical examination including ear inspection.

What are the treatment options for outer ear infection?

Treatment is generally in the form of:

  • Pain killers to reduce the pain
  • Ear drops to eliminate the swelling and infection (occasionally in severe cases orally)
  • Cleaning of the ear canal if necessary
  • Avoid getting the ears wet during treatment
How do I prevent outer ear infection?

The ENT adage, “Don’t put anything smaller than your elbow in your ear” to clean the ear is true. The ear is self-cleaning; fingers, towels, cotton-tipped applicators, and other devices should not be used to clean the inside of the ears.

If you feel that you need to clean excessive wax from your ears, talk to the ENT doctor  first. They may want to examine your ears to see if the ear wax is excessive. It is normal to have some ear wax (also called cerumen). If you have an excessive amount of ear wax, enquire about safe ways to clean your ears.

If you swim frequently, experts recommend the following tips to reduce the chance of developing external otitis.

  • Shake your ears dry after swimming
  • Blow-dry your ears on a low setting, holding the dryer 12 inches away.
  • Use ear drops after swimming to prevent ear infections; these are available at most pharmacies without a prescription.
  • Consider wearing ear plugs made for swimming.

The content on the Nairobi ENT website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions.


  1. Hajioff, Daniel, and Samuel Mackeith. “Otitis externa.” BMJ clinical evidence2015 (2015).
  2. Schaefer, Paul, and Reginald F. Baugh. “Acute otitis externa: an update.” American family physician11 (2012).

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