External Ear Infections

The ear is divided into three parts: outer ear (pinna and external ear canal), middle ear (behind the ear drum) and inner ear (cochlea). Infections of the outer and middle ear are much more common than inner ear infections.

Figure 1. The ear is divided into three parts as above : outer, middle and inner


This is an infection affecting the external ear canal, commonly known as “swimmer’s ear”. Anyone can get otitis externa. 


The ear canal is usually protected by a waxy, water-resistant coating. Bacteria living on the surface if the skin can cause otitis externa when there is a break in the skin’s barrier. Trauma to the skin of the ear canal from cotton buds or fingernails can result in such a break in barrier. 

Someone who swims frequently is also predisposed to otitis externa. Prolonged exposure to moisture results in water-resistant layer and the skin turning soft. Bacterial invasion follows.

High humidity in tropical countries like Singapore increases the risk. 

Other medical conditions which lower immunity like diabetes or cancer treatment can also result in higher risks. 


  • Itchy painful ear with foul smelling discharge from the ear
  • Decreased hearing
  • Red and swollen external ear skin, sensitive to touch
Figure 2. Diagrammatic representation of the anatomical changes in an external ear infection


Diagnosis is confirmed with a microscopic or otoscopic examination at your doctor’s office. Often times, an examination is critical to differentiate between a bacterial and fungal infection as each treatment approach is different. 


  1. Antibiotic or antifungal ear drops 
  2. Regular ear cleaning at an ENT office 
  3. Instillation of medication into the ear canal or insertion of an ear wick (small surgical material) to hasten healing
  4. Oral or intravenous antibiotics may be instituted for severe infections
  5. Pain medications – ear infections can be very painful and affect work and sleep
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