What Are Outer Ear Infections (Otitis Externa)?

An outer ear infection, also known as otitis externa, refers to an infection in the ear canal, which connects your outer ear to your middle ear. The canal also carries sound from outside your body to your eardrum. An outer ear infection is the most common cause of ear pain, and about one in 10 adults will get an outer ear infection at some point in their lives.

Outer ear infections are usually caused by bacteria, but they can also be caused by fungi like yeast and viruses. Outer ear infections are often called “swimmer’s ear” because germs can easily get into the ear canal while you’re swimming. Sometimes allergic reactions can lead to outer ear infections.

This type of infection is generally mild and clears up in a few days or weeks. However, in rare cases, it can spread to nearby tissues.

female doctor examining a patient's ear
AndreyPopov / Getty Images

Symptoms

An outer ear infection comes with inflammation, tenderness, and ear pain. Symptoms can start within 48 hours. Your child may tell you they have ear pain or fidget with their ear.

Along with ear pain, you may experience the following:

  • Itching
  • Swelling and redness
  • Mild fever in rare cases
  • Partial or complete ear canal obstruction
  • Hearing impairment
  • Jaw pain and pain with chewing
  • Swollen lymph nodes around the ear
  • Ear discharge (first cloudy; then cloudy, yellow, and pus-like)

In about one out of three people, the symptoms are so severe that it affects their everyday lives. About one out of five people has to stay home from work or school for a few days because of the infection.

Causes

Ear canals can get infected for all sorts of reasons. Outer ear infections are usually a result of bacteria. They are less commonly caused by a fungus.

Viral illnesses like the flu or a certain type of shingles (zoster oticus) may also lead to an outer ear infection. Sometimes allergic reactions like to a shampoo can cause an ear infection.

Risk Factors

Swimming, injury to the ear canal, and other things can increase your risk of getting outer ear infections:

  • Swimming: Too much moisture in the ear can irritate and break down the skin in the canal, letting bacteria or fungi penetrate. Therefore, outer ear infections are more common in people who swim a lot.
  • Injury: Minor injuries to the ear, such as through the use of cotton swabs to clean your ear or regularly wearing headphones that you stick inside your ear, can increase the risk too.
  • History of infections: People who have already had an outer ear infection or are generally prone to infections are also more likely to get outer ear infections.
  • Middle ear infection: If someone has a middle ear infection, pus collected in the middle ear can drain into the ear canal through a hole in the eardrum and cause an outer ear infection.

Treatment

In most cases, topical antimicrobials with or without corticosteroids are the primary course of treatment for an acute outer ear infection.

Cost of antibiotic treatment can vary widely, so talk to your provider about price comparisons and insurance coverage. Treatment also includes cleaning the canal or removing any obstructions in some cases.

Topical antibiotic examples include:

  • Broad-spectrum antibiotics (quinolones)
  • Poly-Rx (polymyxin B)
  • VoSol (acetic acid which kills bacteria and fungus)
  • VoSol HC (acetic acid with hydrocortisone)

In extreme cases, you may be given a wick of compressed cellulose or a gauze that can then be inserted into your ear to facilitate medicine administration.

Do not stop taking antibiotics (or administering them to your child) even if you feel better. The infection will return if you do not finish the full course of medication.

How to Use Ear Drops

Ear drops are not always easy to administer. Follow these steps when using them:

  • Lie down on your side with the infected ear facing up.
  • Drip your ear drop along the ear canal side (you don’t need to get the medicine perfectly in the canal).
  • Let it slide into the ear canal, and remain still and relaxed for a few minutes.
  • Sit up slowly. Avoid sticking anything in your ear to soak up the excess ear drop.
  • Let your ear air dry.

 Your doctor may decide oral antibiotic treatment is best if:

  • The infection has already spread beyond your ear canal
  • You have uncontrolled diabetes
  • You are immunocompromised
  • You’ve had radiotherapy to your ear
  • It’s not possible to administer topical antibiotic to the area

You may also treat the ear pain with an oral painkiller such as a nonsteroidal anti-inflammatory drug (NSAID) or Tylenol (acetaminophen).

Examples of common NSAIDs include:

  • Motrin, Advil (ibuprofen)
  • Aspirin (acetylsalicylic acid)
  • Aleve, Anaprox (naproxen)
  • Celebrex (celecoxib)
  • Oruvail (ketoprofen)
  • Orudis (ketoprofen)
  • Relafen (nabumetone)
  • Voltaren (diclofenac sodium)

How Are Ear Tubes Used to Treat Ear Infections?

Tympanostomy, or ear tubes, are a treatment option for people with chronic ear infections, especially children. They provide rapid relief and are recommended for children who are developing their speech and language skills. 

Home Remedies

Depending on how severe your pain is, you may feel relief from using a warm or cold compress on your ear to help relieve the swelling.

Over-the-Counter Ear Drops

There’s insufficient evidence to support that over-the-counter ear drops are as effective as antibiotics or steroids. You should consult your doctor to decide which drop is best for your infection.

Hydrogen Peroxide

About half a dropper full of 3% hydrogen peroxide solution can be used to help clean your ear. You can expect it to bubble and fizz, and you may experience an uncomfortable sensation.

Tilt your head to let it drain, and if necessary, use a hair dryer around the area (not pointed directly into the ear canal) to add some dry heat and remove excess moisture from your ear.

Do not use hydrogen peroxide if you have a hole in your eardrum (tympanic membrane perforation).

Apple Cider Vinegar

There is no definitive study to prove that apple cider vinegar mixed with water is an effective treatment for outer ear infections. However, theory goes that since apple cider vinegar is an acetic acid, and acetic acid is antibacterial, it may work as a treatment for outer ear infections caused by bacteria.

Do not use apple cider vinegar if you have a tympanic membrane perforation.

The apple cider vinegar you have in your refrigerator, if opened, has been exposed to potential contaminants. Even if it hasn’t, apple cider vinegar shouldn’t be used as a replacement for prescription treatment. 

Essential Oils 

Essential oils are not FDA regulated, and their claims often lack evidence to back up their use. Not only that, but they are potent plant chemicals that can do serious harm, like poisoning.

Talk to your child’s pediatrician for advice, a clear diagnosis, and treatment plan. 

Essential oils should only be ingested with the guidance of a qualified essential oil therapist, and dosed and diluted appropriately for safety. Because essential oils are fat soluble, it’s important to eat some sort of dietary fat at the same time they’re taken.

Garlic (Allium Sativum)

Liquid dissolvable allicin (the main bioactive compound found in garlic) mixed with either sterilized water or diluted broth, or combined with menthol (mint), was tested against microorganisms like yeast and one of the most dangerous yet common Gram-positive strains, Staphylococcus aureus.

Allicin showed antimicrobial activities against:

  • Gram-positive bacteria
  • Gram-negative bacteria
  • Yeast

Note, however, that using essential oils, including garlic oil, always comes with some risk of an adverse reaction, including contact dermatitis. Garlic supplements also carry the risk of interfering with other medications and increasing the risk of bleeding. Therefore, these should not be used with blood thinners.

Tea Tree (Melaleuca Alternifolia)

One doctor at the University of Michigan says specifically that tea tree oil is not recommended for use in ears because it could cause damage to the inner ear.

Make sure you’re already accustomed to the oil or active ingredient you are using and that it’s not spoiled. If you run into problems, gently cleanse the area with oily soap and do not continue use. If irritation persists, talk to your doctor.

Possible Complications

You will run into more serious health complications if you delay treatment, because inflammation can progress to:

  • Affecting your hearing (temporary mild hearing loss due to inflammation, clogging, or fullness)
  • Infection spreading to surrounding soft tissue and bone (a medical emergency known as malignant or necrotizing otitis externa), which is rare and occurs primarily in older patients with diabetes and immunosuppressed patients (e.g., patients with HIV/AIDs or patients on chemotherapy)
  • Pus-filled cysts, which can increase the risk of the eardrum bursting

When to Call Your Doctor

You should talk to your doctor or pediatrician about any ear infections and if you or your child has the following symptoms:

  • Fever greater than 101 F (38.3 C)
  • Severe ear pain and drainage from the ear
  • A stiff neck (a sign of meningitis)
  • Pus or blood in the outer ear

Also call your pediatrician if your child is sluggish, can’t stop crying despite efforts to soothe, shows signs of weakness, has a crooked smile, and/or is not walking straight.

Frequently Asked Questions

How can you tell if you have an outer ear infection? 

If you have an ear infection, your ear will start bothering you from inside (expect pain, itching, or a hot and swollen outer ear). Your doctor can diagnose the cause and guide the appropriate course of treatment.

Do I need antibiotics for an outer ear infection? 

Only people with ear infections caused by bacteria need antibiotics. Antibiotics will not work on a viral infection. Likewise, you need an antifungal to treat a fungal infection.

How long does it take for an outer ear infection to heal? 

Healing time is usually seven to 10 days, but this is dependent upon the underlying cause and how well you stick to your medicine routine. It is always important to complete your full course of antibiotics.

What is the difference between an outer ear infection and a middle ear infection?

An outer ear infection is an infection of the canal. A middle ear infection is an infection behind the eardrum and linked to eustachian tube swelling.

A Word From Verywell

We often don’t think much about our ears until there is a problem with one or both. You can’t ignore ear pain, though, as it can be highly bothersome and make sleeping, socializing, and even going to work and school challenging.

You should keep your ears free of headphones or earbuds when there’s an infection. You may not hear others when they’re speaking, and frustrations can grow.

Remember that an ear infection, although contained in a small space, is still an infection that can have you feeling fatigued and generally unwell. It’s more than OK to rest.

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