Swimmer’s Ear (Otitis Externa)

What is swimmer’s ear?

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

We call it “swimmer’s ear” because avid swimmers commonly experience it. But anyone can get it — especially during the warmer months when many people spend more time in the water.

Left untreated, swimmer’s ear may muffle your hearing. In some cases, it can even cause temporary hearing loss. Most of the time, treatment solves any infection-related hearing issues. Healthcare providers treat swimmer’s ear with ear drops.

How common is swimmer’s ear?

Swimmer’s ear is common. About 10% of people in the U.S. will have it at some point. Swimmer’s ear can affect anyone. But kids between the ages of 7 and 14 are most likely to get it.

What are the 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 of your ear.
• Muffled hearing.
• Redness and swelling in your outer ear.
• Swollen lymph nodes around your ear or upper neck.

What causes swimmer’s ear?

Many things can cause swimmer’s ear, but activity that traps water in your ear canal is the most common cause. 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, start multiplying and eventually cause infection.

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

Risk factors for otitis externa

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. (Think cotton swabs, pens, bobby pins or paper clips.) These objects can scratch your ear canal and make infections more likely to develop.
• Live in a tropical climate: Humid environments can increase your risk of swimmer’s ear.
• 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 — swimming in lakes, ponds, rivers, streams and oceans — increases your risk because fresh water may have pollution and contain more bacteria than you’d find in a pool.
• Use earbuds or hearing aids: Dirt and other substances can contaminate hearing aids or earbuds, making ear infections more likely.

What are complications of swimmer’s ear?

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

• Chronic (long-term) ear infections. If you have swimmer’s ear for more than three months, providers call it a chronic ear infection. This can happen if you have a combination of a bacterial and fungal infection. It’s also more common in people with skin conditions (like eczema or psoriasis) and people who have an allergic reaction to their ear drops.
• Cellulitis (deep tissue infection). In rare cases, swimmer’s ear can spread into deeper layers of your skin.
• Bone or cartilage damage (early osteomyelitis). This rare complication can happen if your 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 for swimmer’s ear to worsen into osteomyelitis. But once it does, it can be life-threatening.

How is swimmer’s ear diagnosed?

A provider will examine your ears for redness, swelling or other signs of damage. If you have drainage coming from your ears, providers may take a sample of the fluid to determine what caused the infection. This is valuable information because bacterial infections and fungal infections require 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 laying down. They might also develop vomiting, diarrhea or a decreased appetite.

These two conditions require different treatments. What works for swimmer’s ear won’t work for a middle ear infection, and vice versa. That’s why it’s so important to see your healthcare provider for a proper diagnosis.

How do I get rid of my swimmer’s ear?

In most cases, healthcare providers prescribe ear drops to eliminate the infection. Depending on your situation, your provider might recommend these medications for otitis externa:

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

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

Can swimmer’s ear be prevented?

Yes, keeping your ears dry is the most effective way to prevent swimmer’s ear.

To further reduce your risk, follow these otitis externa self-care tips:

• Avoid swimming in polluted water.
• Don’t stick anything into your ear canal, including cotton swabs.
• 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 bathing, swimming or being in the water. Use a clean towel or a hairdryer set on low.
• Use cotton balls to absorb excess water in your ears when you shower.
• Wear earplugs when you swim or spend time in the water.

What’s the outlook for people with swimmer’s ear?

Swimmer’s ear usually isn’t serious when you get treatment. In most cases, you can expect the infection to go away in about a week. Without treatment, complications — like the spread of infection — can occur. These complications usually require stronger antibiotics or antifungals.

Will swimmer’s ear (otitis externa) go away by itself?

No, it won’t. Swimmer’s ear is an infection in your ear canal that won’t go away unless you treat it. Left untreated, a swimmer’s ear infection may spread to the base of your skull, your brain or your cranial nerves.

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.

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.