Acute diffuse otitis externa (swimmer's ear) consultation

It is the classic end to a hot Australian summer week: a few days of swimming, and then one ear becomes itchy, then sore, then so tender that you can’t bear to lie on it or even touch the side of your face. That is the picture of otitis externa, or “swimmer’s ear” — and a growing number of community pharmacies can now assess it and, where state rules allow, start treatment without a separate trip to the GP.

What is acute diffuse otitis externa?

Otitis externa is inflammation and infection of the outer ear canal — the tube that runs from the opening of the ear to the eardrum. “Acute diffuse” means it has come on quickly and involves the whole canal rather than a single boil. It is different from a middle ear infection, which sits behind the eardrum; otitis externa is in the canal you could (in theory) reach with a cotton bud — though using cotton buds is one of the things that triggers it.

Water trapped in the canal after swimming, showering or humid weather softens the skin and washes away its protective wax, letting bacteria (and sometimes fungi) take hold. Scratching, cotton buds, earphones and hearing aids all add to the irritation. The result is itch, pain that is often worse when you pull on the ear or chew, a feeling of fullness, sometimes discharge, and muffled hearing if the canal swells shut.

Who is it for?

A pharmacy consultation suits otherwise healthy people with the typical symptoms of a simple outer ear infection. As with other pharmacist services, eligibility and any age limits vary by state and territory, so the exact rules depend on where you live.

The pharmacist will ask when it started, whether you’ve been swimming or using cotton buds or earphones, whether there is discharge, how bad the pain is, and about your medical history, allergies and diabetes. They are checking that this is a straightforward case rather than something that needs a doctor.

This service is not appropriate, and you should see a doctor, if you have diabetes or a weakened immune system (these raise the risk of a serious deep infection), if you have a known or suspected hole in the eardrum or have had ear surgery or grommets, if the pain is severe with fever or spreading redness and swelling around the ear, or if symptoms are in both ears in a young child. Some ear drops are unsafe if the eardrum is perforated, which is one reason the assessment matters.

How it works at the pharmacy

In a private area, the pharmacist works through a checklist and, where trained, examines the ear with an otoscope to look at the canal and, importantly, to check the eardrum is intact. If your case fits the protocol, they can recommend or — in participating states — supply treatment. Treatment is usually medicated ear drops that combine an antibiotic or antiseptic with an anti-inflammatory to settle the swelling, along with pain relief such as paracetamol or ibuprofen.

Just as useful is the practical advice. Keep the ear dry while it heals — no swimming, and keep water out in the shower. Don’t poke anything into the ear, including cotton buds. If the canal is very swollen, the drops may not get in well and a doctor may need to place a small wick. The pharmacist will set expectations: it should start easing within a couple of days, and if it isn’t — or is getting worse — you need review.

There is normally a fee for the consultation and for any medicine supplied. Because availability depends on a trained pharmacist being on duty, it’s worth phoning ahead.

Safety and when to see a doctor

Seek medical care if the pain is severe, if there is spreading redness or swelling of the outer ear or face, if you develop a fever, if you have diabetes or are immunocompromised, if symptoms don’t improve within a few days of treatment, or if hearing loss persists. Rarely, otitis externa can spread to the surrounding bone and tissue (a serious condition called malignant otitis externa), particularly in people with diabetes or weakened immunity — which is exactly why those groups are referred rather than treated in the pharmacy.

How it’s regulated in Australia

Pharmacist assessment and treatment of otitis externa is part of the expanding scope of practice for community pharmacists, delivered under state and territory rules rather than one national program. Queensland’s scope of practice program has led the way, with other jurisdictions running their own pilots and trials. Pharmacists who supply treatment complete additional training, follow defined clinical protocols, and are registered with the Pharmacy Board of Australia. The list of conditions and the precise rules differ between states and keep evolving, so check what’s offered where you are.

Official sources

• Healthdirect: swimmer’s ear (otitis externa)
• Healthdirect: can my pharmacist give me a prescription?
• Pharmacy Board of Australia

Phone ahead to confirm the service is available and to check the rules in your state. Use the button below to find a pharmacy listing a swimmer’s ear consultation near you.