The symptoms of an ear infection usually start quickly and include:

• Pain inside the ear
• A high temperature
• Being sick
• A lack of energy
• Difficulty hearing
• Discharge running out of the ear
• A feeling of pressure or fullness inside the ear
• Itching and irritation in and around the ear
• Scaly skin in and around the ear

Most symptoms of ear infections start very quickly and clear up, without treatment, within 3 - 7 days. Complications of otitis externa are uncommon, but some can be very serious.One rare complication of otitis externa is necrotising otitis externa, which is where an infection spreads from the ear canal into the surrounding bone.This requires prompt treatment with antibiotics and sometimes surgery, as it can be fatal if left untreated.

Most cases of otitis media pass within a few days, so there's usually no need to see your GP. However, see your GP if you or your child have:

• Symptoms showing no sign of improvement after two or three days
• A lot of pain
• A discharge of pus or fluid from the ear – some people develop a persistent and painless ear discharge that lasts for many months, known as chronic suppurative otitis media
• an underlying health condition, such as cystic fibrosis or congenital heart disease, which could make complications more likely

Most middle ear infections occur when an infection such as a cold, leads to a build-up of mucus in the middle ear and causes the Eustachian tube (a thin tube that runs from the middle ear to the back of the nose) to become swollen or blocked. This mean mucus can't drain away properly, making it easier for an infection to spread into the middle ear. An enlarged adenoid (soft tissue at the back of the throat) can also block the Eustachian tube. The adenoid can be removed if it causes persistent or frequent ear infections. Read more about removing adenoids.

Younger children are particularly vulnerable to middle ear infections as:

• The Eustachian tube is smaller in children than in adults
• A child's adenoids are relatively much larger than an adults

Certain conditions can also increase the risk of middle ear infections, including:

• Having a cleft palate – a type of birth defect where a child has a split in the roof of their mouth
• Having Down's syndrome – a genetic condition that typically causes some level of learning disability and a characteristic range of physical features

There are several different causes of otitis externa. A number of things can also increase your chance of developing the condition. Causes of otitis externa can include:

• A bacterial infection – usually by bacteria called Pseudomonas aeruginosa or Staphylococcus aureus
• Seborrheic dermatitis – a common skin condition where the naturally greasy areas of your skin become irritated and inflamed, which can sometimes affect the ears
• A middle ear infection (otitis media) – discharge produced by an infection deeper in the ear can sometimes lead to otitis externa
• A fungal infection – such as from the Aspergillus variety and the Candida albicans variety (which also causes thrush); fungal infections are more common if you use antibacterial or steroid ear drops for a long time
• irritation or an allergic reaction – otitis externa can occur because of a reaction to something that comes into contact with your ears, such as ear medication, ear plugs, shampoo or sweat

Otitis externa can also return after previous treatment if you don't complete the full course of recommended treatment.

The following things aren't direct causes of otitis externa, but may make the condition more likely to develop.

Excessive Moisture

Liquid in your ear canal can make you more likely to develop an infection. Moisture provides an ideal environment for bacteria – and to a lesser degree, fungi – to grow.

Your risk may be increased by:

• Swimming – particularly in dirty or polluted water
• Sweating
• Being exposed to humid environments
• Water can also wash away earwax inside your ears, which can make them itchy.

Ear damage

Your ear canal is very sensitive and may become damaged through:

• Scratching inside your ears
• Excessive cleaning
• Inserting cotton buds
• Wearing ear plugs or in-ear headphones for long periods
• Using a hearing aid may also increase your risk of developing otitis externa.

Chemicals

Your chances of getting otitis externa are increased if you use certain products in or near your ears, such as:

• Hair sprays
• Hair dyes
• Earwax softeners
• 
  

Underlying skin conditions

As well as seborrheic dermatitis, certain underlying skin conditions can increase your risk of otitis externa. These include:

• Psoriasis
• Eczema
• Acne
• 
  

Allergic conditions

If you have allergic rhinitis or asthma, you may be at a higher risk of developing otitis externa.

Weak immune system

You may be at higher risk of developing otitis externa if you have a condition that can weaken your immune system, such as:

• Diabetes
• HIV or AIDS
• Certain cancer treatments, such as chemotherapy, may also increase your risk of otitis externa.

Despite many infections being bacterial, antibiotics are not always prescribed, as the infection can clear up on its own and within 3 - 7 days. The advice below should help to relieve your symptoms to some extent and help to prevent complications:

• Avoid getting your affected ear wet – wearing a shower cap while showering and bathing can help, but you should avoid swimming until the condition has fully cleared
• Remove any discharge or debris by gently swabbing your outer ear with cotton wool, being careful not to damage it – don't stick cotton wool or a cotton bud inside your ear
• Remove anything from your affected ear that may cause an allergic reaction, such as hearing aids, ear plugs and earrings
• Use painkillers such as paracetamol or ibuprofen to relieve ear pain – these aren't suitable for everyone, so make sure you check the information leaflet that comes with the medication first; if you're still unsure, check with your GP, practice nurse or pharmacist
• If your condition is caused by a boil in your ear, placing a warm flannel or cloth over the affected ear can help it heal faster

For more severe infections, for example, if your symptoms do not improve after 3 days or you have a very high temperature you are likely to need ear drop medications. There are four main types of ear drops used to treat otitis externa:

• Antibiotic ear drops – this can treat an underlying bacterial infection
• Corticosteroid ear drops – this can help to reduce swelling
• Antifungal ear drops – this can treat an underlying fungal infection
• Acidic ear drops – this can help kill bacteria

Sometimes you may be given medication that's a combination of the above, such as antibiotic and corticosteroid ear drops. Antibacterial drops/sprays such as Otomize Ear Spray or Betnesol-N Drops can also be used to relieve symptoms of outer ear infections.

For outer ear infections, you should first clean the ear (being careful not to cause any damage). Gently wash with a small amount of warm water, and dab dry with a clean cloth.You can then apply antibacterial medication to the affected area.

Pharmacinta offers the spray Otomize, containing the active ingredients neomycin (an antibiotic) and dexamethasone (a steroid). It is easy to apply and effective at treating mild to moderate infections. Otomize is a fast-acting spray for the treatment of inflammation and infections of the external part of the ear. Easing painful, unpleasant symptoms by treating them right from the source. We also offer the Betnesol-N Drop which is an antibacterial drop that can also help with relieving the symptoms of otitis externa.

Inner ear infections are difficult to prevent as they are often triggered by cold or the flu. There are however things that can be done to try and prevent infections of the outer ear. These include:

• Avoid cleaning your ears with cotton wool buds or putting your fingers in your ears
• Wear earplugs or a swimming hat over your ears when you swim
• Avoid water or shampoo getting into your ears when you have a shower or bath

If necessary, there are some other treatments your GP can provide to help treat otitis externa, such as:

• Stronger prescription painkillers such as codeine for severe cases
• Antibiotic tablets or capsules to treat a severe infection – an antibiotic called flucloxacillin is usually the preferred choice
• Treatment for underlying skin conditions that may aggravate your otitis externa, such as seborrheic dermatitis, psoriasis or eczema
• If a boil develops inside your ear, your GP may decide to pierce it with a sterile needle and drain the pus – this is known as incision and drainage, and you shouldn't attempt to do it yourself

If necessary, your GP may refer you to a specialist for further treatment. The specialist may decide to remove earwax from inside your ears to help make ear drops more effective. This can be done in a number of ways:

• Syringing or irrigation – where water is injected through the nozzle of a syringe into the ear canal to dislodge and wash away any earwax
• Micro suction – where a small suction device is used to remove any earwax, discharge and debris from your outer ear and ear canal
• Dry swabbing – this gently mops out earwax from your ear canal

You may also need an ear wick, which is a soft cotton gauze plug covered with medication and inserted into your ear canal. An ear wick allows the medication to reach the end of your ear canal. It should be changed every two to three days.

Frequently Asked Questions