Swimmer’s Ear (Otitis Externa)

Swimmer’s ear (otitis externa) is an ear canal infection. Your ear canal is the pathway between your outer ear and middle ear. Swimmer’s ear can be a bacterial infection or fungal infection.

It’s called “swimmer’s ear” because avid swimmers commonly get it. But anyone can get it, especially during the warmer months when many people spend more time in the water. It’s a common condition, affecting about 1 in 10 people in their lifetimes. It happens most in older children and young teens.

Without treatment, swimmer’s ear may muffle your hearing. In some cases, it can even cause temporary hearing loss. Usually, treatment solves any infection-related hearing issues in about seven to 10 days. Healthcare providers treat swimmer’s ear with prescription ear drops.

Symptoms of otitis externa

Swimmer’s ear symptoms can be mild or severe and may include:

• A feeling of fullness in your ear
• Ear pain that may increase when gently tugging on your earlobe
• Fever
• Fluid draining from your ear
• Itchiness inside your ear
• Muffled hearing
• Redness and swelling in your outer ear
• Swollen lymph nodes around your ear or upper neck

Swimmer’s ear causes

Many things can cause swimmer’s ear, but trapped water in your ear canal is the most common. Bacteria and fungi thrive in warm, moist places. So, water pooling in your ear canal is the perfect environment for bacteria and fungi to settle in and grow. Eventually, they can cause infection.

It’s much more common to get swimmer’s ear from a bacterium than a fungus. In rare cases, a combination of germs can cause it. Bacteria that can cause the condition include Pseudomonas aeruginosa and Staphylococcus aureus. Fungi that can cause it include Candida and Aspergillus.

Risk factors

You’re more likely to develop swimmer’s ear if you:

• Have certain skin conditions: Eczema or psoriasis in your ear canal increases your risk of developing swimmer’s ear.
• Injure your ear: You can damage your ear canal by sticking objects in your ear to try to remove earwax, like cotton swabs. Foreign objects can scratch your ear canal and make infections more likely to develop.
• Live in the tropics: Humid environments can increase your risk of otitis externa.
• Lose earwax: Earwax protects your ear canal from bacteria and fungi. You may lose earwax because there’s too much water in your ear or because you accidentally remove too much earwax when you clean your ears.
• Swim in fresh water: You can get swimmer’s ear from swimming in pools. But freshwater swimming — in lakes, ponds, rivers, streams and oceans — increases your risk because fresh water contains more bacteria than in a pool.
• Use earbuds or hearing aids: Dirt and other substances can contaminate hearing aids or earbuds, increasing your risk.

Complications of this condition

Swimmer’s ear complications are rare, especially if you treat symptoms quickly. But they can still happen. Possible issues include:

• Chronic ear infections: Swimmer’s ear that lasts for more than three months is called a chronic ear infection. It’s more common in people with certain skin conditions and those who have an allergic reaction to their ear drops.
• Cellulitis (deep tissue infection): In rare cases, otitis externa can spread into deeper layers of your skin.
• Bone or cartilage damage (early osteomyelitis): This rare complication can happen if a swimmer’s ear infection turns into an outer ear infection. The infection can spread into nearby cartilage and bone. It’s most common in people with weakened immune systems.
• Advanced skull base osteomyelitis: If infection from your ear continues to spread into the lower bones of your skull, it can affect nearby nerves, your brain and other areas of your body. It’s rare, but it can be life-threatening.

How doctors diagnose this condition

A healthcare provider will examine your ears for redness, swelling or other signs of damage. If you have drainage coming from your ears, they may take a sample of the fluid to find out what’s causing the infection. This is valuable information because bacterial infections and fungal infections need different treatments.

What can be mistaken for swimmer’s ear?

It’s easy to confuse swimmer’s ear with a middle ear infection — another common childhood condition. Typically, kids with a middle ear infection have pain that gets worse when lying down. They might also have vomiting, diarrhea or a decreased appetite.

These two conditions require different treatments. What works for one type of infection won’t work for the other. That’s why it’s so important to see a healthcare provider for a proper diagnosis.

How is swimmer’s ear treated?

First, your healthcare provider will clean your ear canal to get rid of dead cells. Then, they’ll prescribe ear drops to get rid of the infection. Depending on your situation, your provider might recommend:

• Antibiotic ear drops to fight bacteria
• Antifungal ear drops to fight fungi
• Steroid ear drops to reduce inflammation

Follow the instructions on the bottle closely to be sure you’re applying ear drops correctly. You’ll want the medicine to reach your entire ear canal.

You can also take over-the-counter (OTC) pain relievers, like acetaminophen (Tylenol^®) or ibuprofen (Advil^®), to ease any discomfort.

Otitis externa self-care

It’s important to protect your ears while you wait for the ear drops to work. Here are some tips:

• Avoid swimming.
• Avoid wearing earplugs or earbuds.
• Waterproof your ears by placing a cotton ball with petroleum jelly (Vaseline^®) in your ears when you bathe.

Once you’re better, be sure to disinfect earbuds or earplugs before wearing them again.

How long does swimmer’s ear last?

With treatment, most infections go away in about seven to 10 days. Symptoms usually start to improve within two to three days.

When should I see my healthcare provider?

Schedule an appointment with your healthcare provider if you develop any swimmer’s ear symptoms, like ear pain, drainage, itchiness or muffled hearing.

If a healthcare provider has already prescribed ear drops for a swimmer’s ear infection, call them if you still have symptoms 10 days later. You might need a stronger medication.

What can I expect if I have swimmer’s ear?

Swimmer’s ear usually isn’t serious when you get treatment. It usually goes away in about a week.

But you’ll need treatment from your primary care provider or an otolaryngologist (ENT) before things improve. Swimmer’s ear won’t go away by itself. Without treatment, complications — like the spread of infection — can occur. These complications usually require stronger antibiotics or antifungals.

Because infection can spread beyond your outer ear, it’s important to schedule an appointment with your healthcare provider whenever you notice symptoms. The sooner you treat it, the better.

Can swimmer’s ear be prevented?

Yes, keeping your ears dry is the most effective way to prevent it. You can:

• Wear earplugs when you swim or spend time in the water.
• Use cotton balls to absorb excess water in your ears when you shower.
• Drain water from your ears by tipping your head from side to side and gently pulling your earlobe in different directions.
• Dry your ears after being in water. Use a clean towel or a hairdryer set on low.

It’s also important to protect your ear canal’s delicate lining, so it doesn’t tear and allow germs in. This includes not sticking anything into your ear canal, like cotton swabs.