Otitis externa (outer ear canal infection)
Otitis externa is an infection or inflammation of the skin of the ear canal. It is a common condition that often causes significant pain, ear discharge, and temporary hearing loss due to swelling or debris blocking the canal.
Common Causes
- Water exposure ("swimmer's ear")
- Use of cotton buds or objects in the ear
- Eczema or skin conditions
- Hearing aids or earplugs
Treatment and management
Careful cleaning of the ear canal and topical ear drops are the main treatments for otitis externa. Microsuction is often required to effectively remove debris and inflammation products, opening a clear path for the treatment drops to reach the infected skin.
Topical ear drops are usually more effective than oral antibiotics for treating otitis externa. Oral antibiotics are generally reserved for cases where the infection is spreading to the surrounding skin or for high-risk patients who require additional systemic support.
Do I need an ear swab?
Routine ear swabs are not recommended for typical otitis externa because most cases respond to topical therapy, swabs often show no significant growth, results rarely change treatment, and they add cost and delay.
This approach is consistent with UK and international guidance (NICE, BNF, UKHSA, AAO-HNS, European and Australian guidelines), where swabs are reserved for infections that are not settling, keep coming back, are severe, or in people who are immunosuppressed.
We can arrange an ear swab if specifically indicated or if a patient still wishes to have one, but it is often an unnecessary extra cost in straightforward cases.