Swimmer’s Ear: How to Treat and Prevent It

Swimmer’s ear, known medically as acute otitis externa, is a painful infection of the outer ear canal that can disrupt daily life.

This common condition is responsible for an estimated 2.4 million healthcare visits in the United States each year, costing the healthcare system nearly half a billion dollars annually.

While often associated with swimming, anyone can develop this uncomfortable infection. Understanding its causes, recognizing its symptoms early, and knowing the proper treatment and prevention methods are key to managing it effectively and avoiding serious complications.

This comprehensive guide provides an in-depth look at every aspect of swimmer’s ear. We will explore its underlying causes, from water exposure to skin conditions, and detail the full spectrum of symptoms, from mild itching to severe pain.

You will learn about evidence-based treatments, including over-the-counter remedies and prescription drops and discover expert-backed strategies to prevent future infections.

By the end of this article, you will have the knowledge to protect your ears and handle swimmer’s ear with confidence.

What Is Swimmer’s Ear (Otitis Externa)?

Swimmer’s ear is an inflammation or infection of the external auditory canal, which is the tube running from your outer ear to your eardrum.

While its common name points to swimming as a frequent cause, the condition is fundamentally a skin infection within the ear canal, similar to cellulitis. It can be caused by bacteria and less commonly, by fungi.

A Deeper Look at the Anatomy of the Ear Canal

To understand swimmer’s ear, it helps to know the structure of the external ear. The ear canal is about 2.5 centimeters (1 inch) long in adults.

The outer third is framed by cartilage and contains hair follicles and specialized glands that produce cerumen, or earwax.

This waxy, acidic substance is crucial for ear health, it creates a protective, waterproof barrier and inhibits the growth of bacteria and fungi.

The inner two-thirds of the canal is encased in bone, with a very thin layer of skin directly over it.

When this protective cerumen layer is compromised—either washed away by excess moisture or removed by objects—the delicate skin of the ear canal becomes vulnerable to infection.

Defining Otitis Externa: More Than Just a Swimmer’s Problem

The medical term, otitis externa, breaks down into “otitis” (inflammation of the ear) and “externa” (external).

It is distinct from a middle ear infection (otitis media), which occurs behind the eardrum.

According to the American Academy of Family Physicians, over 90% of cases are caused by bacteria.

The most common culprits are Pseudomonas aeruginosa and Staphylococcus aureus, which thrive in moist, warm environments.

This is why activities that trap water in the ear, like swimming, bathing, or even living in a humid climate, are major risk factors.

However, any trauma to the ear canal, such as cleaning with cotton swabs or wearing earbuds, can also break the skin and introduce bacteria, leading to an infection.

Acute vs. Chronic Swimmer’s Ear: What’s the Difference?

Otitis externa is typically classified based on its duration:

• Acute Otitis Externa: This is the most common form, with symptoms lasting less than six weeks. It presents with a rapid onset of pain, redness and swelling. With proper treatment, it usually resolves within 7 to 10 days.
• Chronic Otitis Externa: If symptoms persist for more than three months, the condition is considered chronic. According to Cleveland Clinic, this can be caused by a persistent bacterial or fungal infection, an underlying skin condition like eczema, or an allergic reaction to ear drops. Itching is often a more dominant symptom than pain in chronic cases.

What Are the Telltale Symptoms of Swimmer’s Ear?

The symptoms of swimmer’s ear can progress from mild to severe. Recognizing them early is crucial for prompt treatment and preventing complications.

The clinical presentation can be divided into stages based on severity.

Early and Mild Symptoms to Watch For

In its initial stages, swimmer’s ear often presents with subtle signs. You might notice:

• Itching: A persistent itch inside the ear canal is often the very first symptom.
• Mild Discomfort: A feeling of fullness or slight discomfort that may come and go.
• Redness: The ear canal may appear slightly red upon inspection, though this can be hard to see on darker skin tones.
• Clear, Odorless Drainage: A small amount of clear fluid may drain from the ear.

Moderate Symptoms: When the Infection Takes Hold

As the infection progresses, the symptoms become more pronounced and uncomfortable:

• Increasing Pain: The pain becomes more intense and is a hallmark of the condition. A classic sign, noted by the Centers for Disease Control and Prevention (CDC), is pain that worsens when you tug on your outer ear (pinna) or press on the small cartilage bump in front of your ear (tragus).
• More Drainage: The fluid draining from the ear may increase in volume and become pus-like (yellow or white).
• Muffled Hearing: Swelling and debris in the ear canal can block sound, leading to a sensation of muffled hearing or temporary hearing loss.
• Redness and Swelling: The ear canal becomes visibly more swollen and red.

Severe Symptoms: A Sign of Advanced Infection

If left untreated, swimmer’s ear can become severe, with symptoms that indicate the infection may be spreading:

• Severe Pain: The pain can become excruciating, radiating to the face, neck, or side of the head.
• Complete Blockage: The ear canal may swell completely shut, significantly worsening hearing loss.
• Swollen Lymph Nodes: You may feel tender, swollen lumps around the ear or in the upper neck.
• Fever: The development of a fever suggests the infection is spreading beyond the ear canal.
• Redness of the Outer Ear: The infection can cause cellulitis, making the entire outer ear red and swollen.

What Causes Swimmer’s Ear and Who Is at Risk?

The primary cause of swimmer’s ear is a breakdown of the ear canal’s natural defenses, allowing bacteria or fungi to invade the skin.

Several factors can contribute to this breakdown, increasing your risk of developing the infection.

The Main Culprits: Bacteria and Fungi

The warm, dark, and potentially moist environment of the ear canal is an ideal breeding ground for microorganisms. According to research published in StatPearls, the most common pathogens are:

• Bacteria (over 90% of cases): Pseudomonas aeruginosa is the most frequent offender, often found in water and soil. Staphylococcus aureus is another common bacterial cause.
• Fungi (less than 10% of cases): Fungal infections, known as otomycosis, are typically caused by Aspergillus or Candida species. They are more common in tropical climates and in people who have recently used antibiotic ear drops.

Key Risk Factors for Developing Swimmer’s Ear

While anyone can get swimmer’s ear, certain conditions and behaviors significantly increase your risk.

The Cleveland Clinic and other health authorities highlight the following major risk factors:

• Excess Moisture: This is the most significant risk factor. Water from swimming, bathing, or even heavy sweating can wash away protective earwax and create a moist environment for germs to grow. Swimming in fresh water like lakes and rivers may carry a higher risk than pools due to higher bacteria counts.
• Ear Canal Trauma: Putting objects in your ear can scratch the delicate skin, creating an entry point for infection. This includes cotton swabs, fingers, bobby pins, or paper clips. Aggressive cleaning can also remove too much protective earwax.
• Use of Ear Devices: Earbuds, hearing aids, and earplugs can trap moisture and introduce bacteria into the ear canal. They can also cause minor irritation that makes the skin more susceptible to infection.
• Underlying Skin Conditions: People with chronic skin conditions like eczema, psoriasis, or seborrheic dermatitis are more prone to otitis externa because their skin barrier is already compromised.
• Narrow Ear Canals: Some people are born with narrower ear canals, which can trap water and debris more easily.
• Humid Climates: Living in a hot, humid environment increases sweating and moisture in the ear canal.
• Weakened Immune System: Individuals with conditions like diabetes, HIV, or those undergoing chemotherapy are more susceptible to infections in general, including a more severe form of swimmer’s ear.

How Is Swimmer’s Ear Diagnosed by a Doctor?

Diagnosing swimmer’s ear is typically straightforward and can be done by a healthcare professional during an office visit.

A correct diagnosis is essential to ensure you receive the right treatment, as swimmer’s ear can be confused with other ear conditions.

The Physical Examination

A doctor will diagnose swimmer’s ear based on your symptoms and a physical exam. The process usually involves:

1. Discussing Your Symptoms: The doctor will ask about your pain, itching, drainage and hearing changes. They will also ask about recent activities like swimming and your habits regarding ear cleaning.
2. Visual Inspection: The doctor will look at your outer ear for signs of redness and swelling.
3. The “Tug Test”: A key diagnostic sign is pain when the doctor gently pulls on your earlobe (pinna) or presses on the tragus. This tenderness is characteristic of an outer ear infection, not a middle ear infection.
4. Otoscopic Exam: Using a lighted tool called an otoscope, the doctor will look inside your ear canal. They will check for redness, swelling and the presence of debris or pus. This exam also allows them to check your eardrum (tympanic membrane) to ensure it is intact and not perforated.

Differentiating Swimmer’s Ear from a Middle Ear Infection

It’s crucial to distinguish swimmer’s ear (otitis externa) from a middle ear infection (otitis media), as their treatments are very different.

A middle ear infection occurs behind the eardrum and is common in children, often accompanying a cold or respiratory infection.

Feature	Swimmer’s Ear (Otitis Externa)	Middle Ear Infection (Otitis Media)
Location of Infection	Outer ear canal	Middle ear (behind the eardrum)
Pain on Tug Test	Yes, pain when pulling the outer ear	No, pain is not affected by pulling the ear
Primary Cause	Bacterial or fungal infection from moisture/trauma	Often follows a cold or respiratory infection
Eardrum Appearance	Usually normal, but may be red or obscured by swelling	Often bulging, red, with possible fluid behind it
Associated Symptoms	Itching in the ear canal is common	Often accompanied by fever, cold symptoms and pain that worsens when lying down
Treatment	Topical antibiotic/antifungal ear drops	Often requires oral antibiotics

When Are Further Tests Needed?

In most cases, no further testing is required. However, if the infection is severe, recurrent, or not responding to initial treatment, your doctor might take a sample of the fluid or debris from your ear.

This sample is sent to a lab to identify the specific bacteria or fungus causing the infection, which helps in choosing a more targeted medication.

How Do You Treat Swimmer’s Ear Effectively?

The primary goals of treating swimmer’s ear are to clear the infection, allow the ear canal to heal and manage pain.

Treatment is highly effective, with most cases resolving within a week to 10 days.

Step 1: Cleaning the Ear Canal

Before any medication can work effectively, the ear canal must be clear of debris, pus, and excess earwax.

A healthcare provider will perform this cleaning (also called aural toilet) in their office using gentle suction or a small tool called an ear curette.

This step is critical because it allows the medicated ear drops to reach all infected surfaces of the skin.

Important: Do not attempt to clean the inside of your ear canal yourself, especially with cotton swabs. This can push debris further in, cause more trauma and worsen the infection.

Step 2: Medicated Ear Drops

Topical medications are the cornerstone of treatment for uncomplicated swimmer’s ear. Oral antibiotics are rarely necessary unless the infection has spread.

According to the American Academy of Otolaryngology—Head and Neck Surgery, prescribed ear drops usually contain a combination of ingredients:

• An Acidic Solution: Helps restore the ear’s natural acidic pH, which discourages bacterial growth.
• An Antibiotic: To kill the bacteria causing the infection. Quinolone-based drops (like ofloxacin or ciprofloxacin) are common.
• A Corticosteroid: To reduce inflammation, swelling, itching and pain. Examples include hydrocortisone or dexamethasone.
• An Antifungal: If a fungal infection is suspected or confirmed, an antifungal medication like clotrimazole will be prescribed.

If the ear canal is severely swollen, the doctor may insert a small sponge or gauze wick into the canal.

The wick is saturated with the medicated drops, ensuring the medicine stays in contact with the swollen skin. The wick is typically removed after 2 to 3 days.

How to Apply Ear Drops Correctly

Proper application is key to the treatment’s success. Follow these steps, as recommended by medical experts:

1. Wash your hands thoroughly with soap and water.
2. Warm the bottle by holding it in your hands for a few minutes. Cold drops can cause dizziness.
3. Lie on your side with the infected ear facing up.
4. Gently pull the outer ear to straighten the ear canal. For adults, pull the earlobe up and back. For children, pull down and back.
5. Apply the prescribed number of drops into the ear canal, avoiding touching the dropper tip to the ear to prevent contamination.
6. Stay on your side for 3 to 5 minutes to allow the medicine to travel down the canal. Gently pressing the tragus can help the drops penetrate.

Step 3: Pain Management

Swimmer’s ear can be very painful. To manage discomfort while the medication takes effect, you can use:

• Over-the-counter pain relievers: Acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve) can be very effective.
• Warm compress: Applying a warm, dry washcloth to the outside of the ear can provide soothing relief.

Step 4: Keeping the Ears Dry During Treatment

It is absolutely essential to keep your ears dry during the entire treatment period to allow them to heal. Mayo Clinic advises the following:

• No swimming or scuba diving.
• Avoid wearing earbuds, hearing aids, or earplugs until all pain and discharge have stopped.
• Protect your ears during showers or baths. Place a cotton ball coated with petroleum jelly in the outer ear to act as a barrier.

What Are the Potential Complications of Swimmer’s Ear?

While most cases of swimmer’s ear resolve without issue, delaying treatment can lead to rare but serious complications.

These are more likely to occur in individuals with diabetes or weakened immune systems.

Common but Manageable Complications

• Chronic Otitis Externa: An infection that lasts for more than three months. It can result from an inadequately treated acute infection, a mixed bacterial-fungal infection, or an underlying skin condition.
• Temporary Hearing Loss: Caused by swelling and debris blocking the ear canal. Hearing typically returns to normal after the infection clears.
• Periauricular Cellulitis: The infection can spread to the skin and soft tissues of the outer ear and surrounding face. This requires oral or intravenous (IV) antibiotics.

Necrotizing (Malignant) Otitis Externa: A Medical Emergency

This is the most severe complication of swimmer’s ear. Despite the name “malignant”, it is not a cancer but an aggressive, life-threatening infection that spreads from the ear canal into the temporal bone of the skull.

According to Medscape, necrotizing otitis externa (NOE) has a mortality rate of up to 20%, even with treatment.

Who is at risk? NOE almost exclusively affects:

• Older adults with poorly controlled diabetes.
• Individuals with compromised immune systems (e.g., from HIV/AIDS, chemotherapy, or immunosuppressant drugs).

Symptoms of NOE include:

• Severe, deep-seated ear pain that worsens at night.
• Persistent foul-smelling drainage from the ear.
• Granulation tissue (abnormal, fleshy tissue) visible in the ear canal.
• In advanced cases, facial nerve palsy (drooping of one side of the face) and involvement of other cranial nerves.

NOE is a medical emergency that requires immediate hospitalization, long-term IV antibiotics (often for 4-6 weeks) and sometimes surgical removal of infected bone.

Any suspicion of this condition warrants an urgent visit to an emergency room or an otolaryngologist (ENT specialist).

How Can You Prevent Swimmer’s Ear?

Prevention is the best strategy for dealing with swimmer’s ear. The key is to keep your ears dry and maintain the health of your ear canal’s skin. The CDC provides clear, actionable steps to reduce your risk.

Keep Your Ears Dry

Moisture is the number one enemy. Follow these tips to keep your ear canals dry:

• Dry thoroughly after water exposure: After swimming or showering, tilt your head to each side to let water drain out. Gently dry your outer ear with a towel.
• Use a hairdryer: You can use a hairdryer on its lowest, coolest setting, held several inches from your ear, to help evaporate any remaining moisture.
• Wear earplugs for swimming: Use silicone or wax earplugs to create a waterproof seal. Avoid foam earplugs, as they are not effective at keeping water out.
• Use a swim cap: A snug-fitting swim cap can provide an extra layer of protection over your ears.
• Consider preventive drops: If you are prone to swimmer’s ear, talk to your doctor about using over-the-counter ear-drying drops (often a mix of rubbing alcohol and acetic acid) after swimming. Do not use these drops if you have ear tubes or a perforated eardrum.

Protect Your Ear Canal

Avoiding trauma to the ear canal is just as important as keeping it dry.

• Don’t put objects in your ear: This is the golden rule of ear care. Avoid using cotton swabs, keys, hairpins, or your fingers to clean or scratch your ears. This can cause tiny cuts in the skin and push wax and debris deeper.
• Let earwax do its job: Earwax is not dirt, it’s a natural, protective substance. It has antibacterial properties and helps keep the ear canal skin healthy. Over-cleaning removes this protective layer.
• Protect ears from irritants: When using hairsprays or hair dyes, place cotton balls in your outer ears to prevent chemicals from getting into the ear canal.

When Should You See a Doctor for Ear Pain?

While some minor ear discomfort can be managed at home, it’s important to seek medical attention to get an accurate diagnosis and appropriate treatment, especially to rule out more serious conditions.

You should schedule an appointment with your healthcare provider if you experience:

• Any of the moderate to severe symptoms of swimmer’s ear, such as significant pain, pus-like drainage, or muffled hearing.
• Ear pain that doesn’t improve within a day or two.
• Symptoms that persist or worsen after 72 hours of starting treatment.
• You have an underlying condition like diabetes or a weakened immune system.

Seek immediate medical care or go to an emergency room if you develop:

• Severe, radiating pain.
• High fever.
• Swelling or redness that spreads to your face or neck.
• Any signs of facial weakness or drooping.

Frequently Asked Questions About Swimmer’s Ear

1. Is swimmer’s ear contagious?

No, swimmer’s ear is not contagious. According to the CDC, you cannot catch it from another person. It is an infection of the skin in the ear canal, not a communicable disease.

2. Can you get swimmer’s ear without swimming?

Yes. Any activity that introduces moisture or causes trauma to the ear canal can lead to swimmer’s ear. This includes showering, using earbuds, cleaning your ears with cotton swabs, or even living in a very humid climate.

3. How long does it take for swimmer’s ear to go away?

With proper treatment, such as prescription ear drops, symptoms of acute swimmer’s ear typically start to improve within 48 to 72 hours. Most infections are completely resolved in 7 to 10 days.

4. What’s the difference between swimmer’s ear and a middle ear infection?

Swimmer’s ear (otitis externa) is an infection of the outer ear canal. A middle ear infection (otitis media) is behind the eardrum. A key difference is that swimmer’s ear causes pain when the outer ear is tugged.

5. Can I use hydrogen peroxide for swimmer’s ear?

Using hydrogen peroxide is not recommended for treating an active infection. It can be irritating to the inflamed skin and is not an effective treatment. Stick to prescribed medications from your doctor for the best outcome.

6. Can I treat swimmer’s ear at home?

While you can manage mild pain with over-the-counter analgesics, treating the infection itself requires a diagnosis and prescription medication from a doctor. Home remedies are not effective for clearing a bacterial or fungal infection.

7. When can I go swimming again after having swimmer’s ear?

You should avoid swimming for the entire duration of your treatment, typically 7 to 10 days. Your doctor will advise you when it is safe to return to the water, which is usually after all symptoms have completely resolved.

8. Are some people more prone to swimmer’s ear?

Yes. People with narrow ear canals, underlying skin conditions like eczema, or those who produce less earwax are naturally more susceptible. Frequent swimmers and those who live in humid climates are also at higher risk.

Conclusion

Swimmer’s ear, or otitis externa, is a common and painful infection, but it is both highly treatable and preventable.

The key to effective management lies in early recognition of symptoms—such as itching, pain when tugging the ear and drainage—and seeking prompt medical care.

Treatment, centered on medicated ear drops and keeping the ear dry, is typically successful within a week.

Even more powerful is prevention. By adopting simple habits like thoroughly drying your ears after water exposure, avoiding the use of cotton swabs, and protecting your ears with plugs when swimming, you can significantly reduce your risk of developing this uncomfortable condition.

For those with underlying risk factors, being extra vigilant is crucial to avoid recurrent infections and potential complications like necrotizing otitis externa.

We encourage you to use this guide as a resource for protecting your ear health. If you have found this information helpful, please consider sharing it with friends and family.

Do you have a personal experience with swimmer’s ear or a prevention tip that works for you? Share it in the comments below!