Otitis externa is a common and usually treatable ear problem, but it can be surprisingly painful and is easy to confuse with other causes of earache. Knowing what it is, how it is treated in the UK, and when it needs a clinician's attention helps you settle it quickly and avoid it coming back. This guide walks through the typical symptoms, the self-care that genuinely helps, how antibiotic-and-steroid ear drops are used, and the warning signs that mean you should seek review.
What otitis externa is and typical symptoms
Otitis externa is inflammation of the external ear canal — the passage between the outer ear and the eardrum. It is often called swimmer's ear because water trapped in the canal can soften the skin and let bacteria or, less commonly, fungi take hold. It is different from otitis media, which is an infection behind the eardrum in the middle ear and tends to cause deeper pain, often during or after a cold.
Typical symptoms include ear pain that is often worse when you tug the outer ear or chew, itching in the canal, a feeling of fullness or blockage, reduced hearing, and sometimes a watery or pus-like discharge. The canal may look red and swollen. Symptoms can range from a mild irritation to a genuinely severe, throbbing pain, and one ear is usually affected more than the other.
What makes it more likely
Several everyday things raise the chance of otitis externa. Frequent swimming or getting water in the ears is a common trigger, as is humid weather. Cleaning the ears with cotton buds, or scratching the canal with fingernails, hairgrips or the ends of glasses, damages the protective skin and lets infection in. Skin conditions such as eczema or psoriasis affecting the ear, wearing hearing aids or in-ear headphones for long stretches, and a narrow ear canal can all make flare-ups more likely. Recognising your own triggers is a useful first step towards keeping it from returning.
Self-care and keeping the ear dry
Keeping the ear dry is central to both settling and preventing otitis externa. Moisture feeds the problem, so it helps to keep water out while the canal recovers — for example by avoiding swimming for a short time and by keeping shampoo and water out of the ear when washing, using a cotton wool ball smeared with a little petroleum jelly as a temporary plug if needed. After bathing, tilt the head to let water drain and dab the outer ear dry rather than poking inside. Some people find that gently drying the outer ear with a hairdryer on a low, cool setting held at arm's length helps.
Just as important is what not to do. Cotton buds, fingernails and other objects scratch the delicate canal skin and push debris further in, which tends to make inflammation worse rather than better. It is also best to leave earwax alone, as it helps protect the canal. Simple painkillers such as paracetamol or ibuprofen can help with discomfort while treatment takes effect, and a warm flannel held against the ear may be soothing. Mild cases sometimes settle with these measures alone over a few days, but many benefit from ear drops. If pain is disturbing your sleep or making it hard to concentrate, taking pain relief regularly at the recommended dose for a day or two, rather than only when the pain peaks, often keeps you more comfortable while the ear settles.
Antibiotic and steroid ear drops
Most cases of otitis externa that need treatment clear with ear drops or sprays that combine an antibiotic, to tackle infection, and a steroid, to calm inflammation and swelling. In the UK these are typically used for around 7 to 14 days. Products such as Otomize spray and Cetraxal Plus drops are examples of antibiotic-and-steroid preparations used for the ear canal. Symptoms usually start to improve within a few days of starting treatment, but it is important to complete the course your clinician recommends rather than stopping as soon as you feel better, as stopping early can let the infection return. Antibiotics taken by mouth are not usually needed for straightforward otitis externa, because the drops deliver treatment directly to where it is needed.
Applying drops correctly makes a difference: warming the bottle briefly in your hand, lying with the affected ear upwards, gently pulling the outer ear to straighten the canal, and staying still for a few minutes helps the medicine reach where it is needed. A brief stinging or warmth as the drops go in is common. If the canal is very swollen, a clinician may sometimes need to arrange for it to be cleaned or for a small sponge wick to be inserted so drops can get through; the wick is usually removed or falls out as the swelling settles. If itching rather than infection seems to be the main problem, a steroid drop or a treatment aimed at a fungal cause may be more appropriate, which is one reason a proper assessment helps.
Preventing recurrence
Otitis externa has a habit of returning in people who are prone to it, so prevention is worthwhile. The same principles apply: keep the ears dry, dry them gently after swimming or showering, and resist the urge to clean inside the ear with cotton buds — earwax is protective, and over-cleaning removes that natural barrier. Swimmers may find well-fitting earplugs and drying the ears thoroughly afterwards helpful, and some people benefit from tilting the head to each side to let trapped water run out. If you have eczema or another skin condition affecting the ears, managing that skin can reduce flare-ups.
If you use hearing aids or in-ear headphones for long periods, giving the ears time to breathe and keeping devices clean can also help. Acidifying or drying ear drops are sometimes suggested for people who get repeated episodes, particularly frequent swimmers, and your clinician can advise whether this is worth considering for you. Recurrent or stubborn cases sometimes need a swab so treatment can be matched to the specific bug involved, especially if a fungal infection is suspected after courses of antibiotic drops.
When to seek clinical review
Most otitis externa settles with the measures above, but some situations need a clinician's assessment. Seek review if symptoms are severe, if they are spreading to the outer ear or the skin around it, if there is significant swelling, fever, or facial pain, or if symptoms are not improving after a few days of treatment. Diabetes or a weakened immune system, discharge that persists, or hearing that does not recover also warrant a proper look, and a swab may be needed to guide treatment.
Very rarely, an ear infection in someone with diabetes or a weakened immune system can spread to the surrounding bone, causing severe, unrelenting pain — this needs urgent attention. You should also seek prompt advice if you have sudden hearing loss, dizziness, or a discharge following an injury to the ear, as these point away from simple otitis externa. When in doubt, it is always reasonable to have the ear looked at rather than to keep treating at home.
If you are unsure whether your earache is otitis externa or something else, a consultation can help. Because ear symptoms sometimes travel alongside colds, sinus problems and allergies, you may also find our guides on sinus infections, cold and flu treatment and allergies and respiratory health useful. A UK-registered clinician can confirm what is going on and advise whether treatment is appropriate for you.