Overview

Ear canal infection, also known as otitis externa or “swimmer’s ear,” is an infection of the outer ear canal—the passage that runs from the outside of the ear to the eardrum. This condition is common and can affect people of all ages, but it is particularly prevalent among swimmers and individuals frequently exposed to moisture. Ear canal infections can cause significant discomfort, pain, and temporary hearing difficulties. With proper treatment, most cases resolve quickly without complications.

Causes

Several factors can lead to the development of an ear canal infection:

• Excess moisture: Water trapped in the ear canal after swimming, bathing, or showering creates an ideal environment for bacterial or fungal growth.
• Bacterial infection: The most common cause, typically involving bacteria like Pseudomonas aeruginosa or Staphylococcus aureus.
• Fungal infection: Fungal organisms such as Aspergillus or Candida can cause fungal otitis externa, especially in humid climates.
• Skin conditions: Eczema, psoriasis, or dermatitis can weaken the skin barrier in the ear canal, increasing infection risk.
• Ear trauma: Aggressive cleaning with cotton swabs or inserting foreign objects can cause small abrasions, making the ear susceptible to infection.
• Allergic reactions: Allergies to hair products, earplugs, or hearing aids may cause irritation and lead to infection.

Symptoms

Ear canal infections usually present with a combination of the following symptoms:

• Ear pain: Often severe, worsening when the ear is touched or pulled.
• Itching: Persistent itching inside the ear canal.
• Redness and swelling: Visible inflammation of the ear canal and sometimes the outer ear.
• Ear discharge: Fluid drainage that may be clear, yellow, or pus-like.
• Fullness or pressure: A sensation of blockage in the ear.
• Temporary hearing loss: Due to swelling or blockage by discharge.
• Fever: In more severe infections, especially if the infection spreads.

Diagnosis

Diagnosis of ear canal infection is typically straightforward and involves:

• Medical history: Discussion of recent swimming, ear cleaning habits, or any predisposing conditions.
• Physical examination: Using an otoscope, a healthcare provider examines the ear canal for redness, swelling, and discharge.
• Swab culture: In persistent or severe cases, a sample of ear discharge may be sent for bacterial or fungal culture to guide treatment.
• Hearing assessment: If hearing loss is significant, hearing tests may be conducted to evaluate the extent of impairment.

Treatment

Treatment focuses on eliminating the infection, relieving symptoms, and preventing recurrence:

• Ear drops: Antibiotic or antifungal ear drops are the primary treatment. Combination drops may include corticosteroids to reduce inflammation and itching.
• Pain management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain.
• Ear cleaning: In some cases, a healthcare provider may need to gently clean the ear canal to remove debris and allow the medication to work effectively.
• Keep ear dry: Avoid swimming and keep the ear dry during treatment to promote healing.
• Oral antibiotics: Rarely needed but may be prescribed if the infection spreads beyond the ear canal.

Prognosis

The prognosis for ear canal infections is excellent with prompt and appropriate treatment. Most uncomplicated cases improve within a few days and fully resolve within one to two weeks. Recurrent cases can often be prevented by adopting good ear care practices, such as avoiding over-cleaning, keeping the ears dry, and managing underlying skin conditions.

If left untreated, complications like chronic otitis externa, abscess formation, or spread of infection to nearby tissues can occur. With early medical attention, these complications are rare, and the vast majority of people recover without long-term problems.