Infection of the ear canal — painful, itchy and often triggered by water or cotton buds.
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Otitis externa is infection or inflammation of the ear canal — the outer ear — as opposed to the middle ear behind the drum. It causes pain, itch and discharge, and it is often called swimmer's ear, though most cases have nothing to do with swimming.
The simplest way to tell it apart from a middle ear infection: pull gently on your earlobe, or press the little flap in front of the canal. If that hurts, the problem is in the outer ear. Middle ear infections do not hurt when you move the ear.
Two things worth knowing:
One situation is genuinely dangerous and must not be missed: severe, unrelenting ear pain in someone with diabetes or a weakened immune system, particularly if it is worse at night or there is facial weakness. That may be a spreading bone infection requiring hospital treatment.
Where it persists beyond a few weeks: itch dominates rather than pain, the canal is dry and scaly, and there is often an underlying skin condition — eczema, psoriasis or seborrhoeic dermatitis — or a fungal infection after repeated antibiotic drops.
The ear canal is protected by a thin layer of slightly acidic wax. Anything that removes that layer or breaks the skin lets bacteria in — usually pseudomonas or staphylococcus.
Worth knowing about, because it explains a common frustration. Repeated courses of antibiotic ear drops can allow a fungal infection to take hold, which then does not respond to more antibiotic drops. It typically causes marked itch, a blocked feeling, and debris sometimes described as looking like damp blotting paper. It needs antifungal treatment and, importantly, cleaning of the canal.
Necrotising (malignant) otitis externa — infection spreading from the canal into the surrounding bone. It occurs almost exclusively in people with diabetes, older adults, and anyone immunosuppressed.
Suspect it where pain is severe, persistent, worse at night and out of proportion, particularly if there is any facial weakness. It requires hospital assessment and prolonged intravenous treatment — and it is missed by treating it as ordinary otitis externa for weeks.
We should be straightforward: we cannot look inside your ear over video, and the canal needs examining to confirm the diagnosis and to check the eardrum.
What a remote consultation does well is establish whether this is likely to be outer ear rather than middle ear, identify the risk factors that change management, and recognise who needs seeing urgently.
Where treatment has failed, where infection is recurrent, in anyone immunosuppressed, or where fungal infection is suspected.
Water is what sustains the infection. No swimming, and keep water out during showers using cotton wool smeared with petroleum jelly. This alone accounts for a substantial proportion of treatment failures when ignored.
Where the canal is swollen shut, a wick is inserted — a small sponge that draws the drops along the canal. This is a common reason treatment fails, and it needs doing in person.
Otitis externa can be genuinely severe. Regular paracetamol and ibuprofen, taken by the clock rather than as needed, and a warm compress against the ear.
Suspected necrotising otitis externa — severe unrelenting pain in someone with diabetes or immunosuppression, particularly with facial weakness. That is an urgent hospital referral, not another course of drops.
Treat any underlying eczema or psoriasis, stop all cleaning, use preventive acidifying drops after swimming, and consider ENT referral for microsuction cleaning — which is often what finally settles a chronically inflamed canal.
Seek urgent same-day assessment for:
Book an appointment for:
The single most effective preventive measure. No cotton buds, no fingers, no hair grips, no towel corners twisted into the canal. The wax you are removing is the protection, and the scratches you cause are the way in.
The ear is self-cleaning. Wash the outer ear only.
Take ear pain seriously and get it assessed promptly rather than persevering with drops. Severe pain, pain worse at night, or pain that is not settling needs urgent review, because the risk of infection spreading into bone is real and the outcome depends heavily on catching it early.
Acetic acid ear spray — sold as EarCalm — is available over the counter for a few pounds and is genuinely effective for mild otitis externa. For an early, mild case that is the sensible first step, and we would say so before charging you for a consultation. Your NHS GP treats it free.
Keeping the ear dry costs nothing and does more than people expect — a shower cap, or petroleum jelly on cotton wool while washing.
Where paying is justified is a painful, swollen, discharging ear that has not settled on acetic acid, where the steroid component of a combination spray such as Otomize is what actually relieves the pain — much of which comes from a swollen canal under pressure.
The honest limitation is that we cannot look in your ear. That matters more here than for most remote prescribing, because the one contraindication that causes lasting harm — a perforated eardrum, which makes neomycin unsafe — can only be excluded with certainty by looking. A careful history covers most of it, and where doubt remains we will ask you to be examined rather than prescribe.
What needs in-person care: a canal so swollen it has closed, which needs microsuction and sometimes an ear wick; severe pain with swelling spreading onto the face or neck; and any severe ear infection in someone with diabetes or a suppressed immune system, where necrotising otitis externa is a serious diagnosis not to be managed over video.
NICE Clinical Knowledge Summary, Otitis externa, is the principal reference. It recommends topical treatment as first-line, covers the use of acetic acid for mild cases and topical antibiotic-steroid combinations for more significant inflammation, and advises against routine oral antibiotics.
NICE CKS is explicit about aminoglycoside-containing preparations and the tympanic membrane — neomycin and gentamicin carry a risk of ototoxicity where there is a perforation, which is the basis for the caution on this page.
ENT UK guidance covers aural toileting, microsuction and the use of ear wicks in a canal too oedematous for topical treatment to penetrate.
CKS also sets out necrotising (malignant) otitis externa — severe pain, granulation tissue, and risk concentrated in older people with diabetes or immunosuppression — as requiring urgent same-day ENT assessment, which underpins the safety advice above.
Pull gently on your earlobe, or press the small flap in front of the ear canal. If that is painful, it is otitis externa. A middle ear infection does not hurt when you move the ear — which is a simple and reliable way to tell them apart, and it changes the treatment completely.
Most often because of cleaning. Cotton buds remove the protective wax and scratch the canal skin, which is exactly how bacteria get in — so the effort to keep ears clean is what causes the infection. Water retained after swimming is the other main reason. Stopping all cleaning, and using acidifying drops after swimming, prevents most recurrences.
Usually one of three reasons. The canal is too swollen for them to get in — which needs a wick inserting. They are running straight back out because you are not lying with the ear uppermost for five minutes. Or after repeated antibiotic courses, the infection has become fungal, which needs different treatment and usually cleaning of the canal.
No, for ordinary otitis externa. Oral antibiotics do not reach the ear canal well and are not the treatment — drops applied directly are. Tablets are reserved for infection spreading beyond the canal or for people who are immunosuppressed.
Not during an episode — water sustains the infection, and this is one of the commonest reasons treatment fails. Once it has settled, use well-fitting earplugs, dry the ears thoroughly afterwards, and consider acidifying drops after each swim if you are prone to it.
Warm the bottle in your hand first, lie down with the affected ear uppermost, put the drops in, then stay lying there for a full five minutes. Pulling the ear gently up and back straightens the canal and helps them reach further. Almost everyone skips the five minutes, and the drops simply run out.
Yes, significantly. Severe or persistent ear pain in someone with diabetes needs prompt assessment rather than another course of drops, because infection can spread into the surrounding bone. Pain that is unrelenting, worse at night, or accompanied by any facial weakness needs urgent hospital review — and the outcome depends on catching it early.
That pattern suggests either a fungal infection — particularly after repeated antibiotic drops — or an underlying skin condition such as eczema or psoriasis affecting the canal. Both need different treatment from a bacterial infection, and scratching to relieve the itch is what keeps it going.
August 24, 2026
Ongoing
Time to be seen
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Your NHS record in the room
Written treatment plan
Told when a test isn’t needed
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Same day, usually
20 minutes
Yes, with your consent
Included
Yes, and told why
£40 for 20 minutes
Varies by practice
Typically 10 minutes
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Usually
Free
Same day
Often 10 to 15 minutes
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Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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