• Nalaka de Silva

Outer Ear Infections

Updated: Jun 16, 2019

Please note that the following is a general guideline only.


What is Otitis Externa or an outer ear infection





Outer ear infections extend from the entrance to the ear canal to the ear drum. The infection usually does not spread any further, unless there is a defect in the ear drum, in which case it may spread to the middle ear.







How do ears protect themselves?


The ear canal is a moist, dark environment where bacteria and fungi may thrive. However, ears keep them from getting infected due to the following reasons.


Oils in the ear canal

The acidity of the ear wax

Antibacterial material in ear wax

Abundant blood supply of the ear canal

Natural shedding of the ear skin outwards




What causes ear infections?


Anything that disrupts the above

Use of cotton buds due to local trauma, and pushing wax against the drum

Allowing dirty water into the ears

Eczema of the ear canals-affects the natural oils production etc

Medical conditions as Diabetes

Excessive use of ear drops: puts ear's natural flora out of balance



What different types of outer infections are there?




1 Rapid onset painful bacterial type. ear canal looks swollen.
















2 Fungal Types. Black spores may be noted with white discharge.















3 Itchy Chronic type: Dermatitis and fungal infections. Ear canal looks irritated and also has white discharge. This may lead to fungal infections.
















4 Rare type which spreads to the skull bones: in immune compromised people. Severe pain and headache with a typical polyp in the ear canal.
















Wick helps deliver drops: must be soaked.












What are the clinical symptoms?


Acute otitis externa: is painful, short duration

Fungal otitis externa: is not as painful, blocked ear canal

Chronic otitis externa: is not painful, itchy can have a secondary acute bacterial infection

Malignant OE: Immune compromised mostly diabetic, deep seeded ear pain





How will this be treated?


Through ear suction first. This should be done by a qualified person. Must avoid syringing as moisture makes the infection worse.


After that a suitable powder may be put in or drops may be given. The treatment should be tailored to the type of infection. If antibacterial treatment is given for a fungal infection, the symptoms may become worse.


If swollen and very painful: may need an ear wick insertion. Wick is a sponge which soaks drops and delivers to the ear canal.


If any suggestion of dermatitis (chronic symptoms): may need longer-term eg once a Monthly steroid ear drops under supervision. This is to control the irritation. This is prescribed after the infection has settled. Excess use of drops may lead to skin thinning. This should be tailored to the patient and be monitored long term.


Usually, oral antibiotics are not necessary unless a severe form of ear infection

Must keep the water out of the ears






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