Otitis Externa (Swimmer’s Ear): Symptoms, Causes, and Treatment in the UK

Otitis externa is a common condition characterised by inflammation, irritation, or infection of the external ear canal. This is the tube leading from the outer ear to the eardrum. In the UK, it is frequently referred to as 'swimmer’s ear' because repeated exposure to water can make the ear canal more vulnerable to inflammation.

Unlike otitis media (an infection of the middle ear behind the eardrum), otitis externa affects the skin of the canal itself. It can be an acute condition that appears suddenly and lasts for a short period, or a chronic issue that persists for several months. According to NICE (National Institute for Health and Care Excellence) guidelines, otitis externa affects approximately 1% of the UK population annually.

The symptoms of otitis externa can range from mild discomfort to significant pain. Recognising the signs early can help prevent the infection from worsening. Key symptoms include:

• Ear pain: This may feel like a dull ache or sharp pain, which often becomes worse when you pull on your outer ear or when you chew.
• Itching: A persistent itch inside the ear canal is often the first sign of inflammation.
• Discharge: You may notice liquid or pus leaking from the ear, which can be clear, white, or yellow.
• Hearing loss: Swelling of the canal or a build-up of debris can cause temporary muffled hearing.
• Redness and swelling: The skin around the entrance to the ear canal may appear red and inflamed.

If the infection spreads, you may also experience a feeling of fullness in the ear or swollen glands in the neck.

Otitis externa occurs when the natural protective barriers of the ear canal are breached, allowing bacteria or fungi to grow. Common causes include:

• Moisture: Swimming, sweating, or humid weather can trap moisture in the ear, creating an ideal environment for bacteria (hence the name 'swimmer’s ear').
• Skin conditions: People with eczema, psoriasis, or seborrhoeic dermatitis are more prone to inflammation of the ear canal.
• Damage to the ear canal: Using cotton buds, matchsticks, or fingers to clean the ear can cause tiny breaks in the skin, leading to infection.
• Allergic reactions: Sensitivity to earplugs, hearing aids, hair dyes, or shampoos can trigger localised inflammation.

The wax in your ears (cerumen) plays a vital role in protecting the canal. Over-cleaning the ears can remove this protective layer, making the skin more susceptible to infection.

In the UK, diagnosis is typically made through a physical examination. A clinician will use an otoscope to look inside the ear to check for swelling, redness, and discharge. Treatment aims to reduce inflammation and clear the infection.

• Cleaning: A healthcare professional may gently clean the ear canal to remove discharge or wax, allowing ear drops to work more effectively.
• Medicated Ear Drops: This is the primary treatment. Depending on the cause, you may be prescribed drops containing antibiotics (for bacterial infections), antifungals, or steroids to reduce swelling.
• Pain Relief: Over-the-counter painkillers such as paracetamol or ibuprofen are often recommended to manage discomfort.
• Keeping the ear dry: It is crucial to prevent water from entering the ear during treatment. Using a shower cap or avoiding swimming for 7 to 10 days is usually advised.

Preventing otitis externa is often more effective than treating recurring bouts. To keep your ears healthy:

• Avoid poking anything into your ear canal, including cotton buds. The ear is 'self-cleaning' and wax will naturally move outward.
• Dry your ears thoroughly after swimming or bathing. Tilt your head to the side to let water drain out and gently pat the outer ear dry.
• Use earplugs or a swim cap if you swim frequently, ensuring they fit well and do not irritate the skin.
• If you have a skin condition like eczema, ensure it is well-managed with the help of a GP.

While mild ear irritation can sometimes resolve on its own, otitis externa often requires prescription treatment to clear completely. You should consult an online GP if:

• Your ear pain is severe or interfering with your sleep.
• Symptoms do not improve after 48 hours of home care.
• You have discharge (fluid or pus) coming from the ear.
• Your hearing is noticeably reduced.
• You have recurring episodes of ear inflammation.

An online consultation allows a GP to assess your symptoms, provide advice on ear care, and issue a prescription for medicated ear drops if required, which can be collected from a local UK pharmacy.