Swimmer’s ear is an infection of the outer ear canal, which runs from your eardrum to the outside of your head (otitis externa). It’s often brought on by water that remains in your ear after swimming or showering, creating a moist environment that aids bacterial and/or fungal growth. Typical symptoms are pain in the ear, pain with moving the ear around or laying on it, ear discharge, and a feeling of fullness or blockage. The ear canal has many sensory nerves, so the pain from this infection can be very intense, often preventing sleep. If left untreated, it can spread to the bone becoming life threatening.
Some ways to prevent swimmer’s ear include minimizing entry of water (a well-fitted swim cap) or drying the ear out after swimming (hair dryer on the lowest setting). Also, avoidance of Q-tips and other irritants to the ear is important as this can traumatize and strip out the ear’s natural protectants. Treatment for swimmer’s ear typically includes combination antibiotic-steroidal-acidifying drops, oral antibiotics and/or antifungal agents.
Swimmer’s ear symptoms are usually mild at first, but they may get worse if your infection isn’t treated or spreads. Doctors often classify swimmer’s ear according to mild, moderate and advanced stages of progression.
When to See a Doctor
Contact your doctor if you’re experiencing any signs or symptoms of swimmer’s ear, even if they’re mild.
- Mild signs and symptoms
- Itching in your ear canal
- Slight redness inside your ear
- Mild discomfort that’s made worse by pulling on your outer ear (pinna, or auricle) or pushing on the little “bump” (tragus) in front of your ear
- Some drainage of clear, odorless fluid
- More intense itching
- Increasing pain
- More extensive redness in your ear
- Excessive fluid drainage
- Discharge of pus
- Feeling of fullness inside your ear and partial blockage of your ear canal by swelling, fluid and debris
- Decreased or muffled hearing
- Severe pain that may radiate to your face, neck or side of your head
- Complete blockage of your ear canal
- Redness or swelling of your outer ear
- Swelling in the lymph nodes in your neck
Swimmer’s ear usually isn’t serious if treated promptly, but complications can occur.
- Temporary hearing loss. You may experience muffled hearing that usually gets better after the infection clears up.
Long-term infection (chronic otitis externa). An outer ear infection is usually considered chronic if signs and symptoms persist for more than three months. Chronic infections are more common if there are conditions that make treatment difficult, such as a rare strain of bacteria, an allergic skin reaction, an allergic reaction to antibiotic eardrops, or a combination of a bacterial and fungal infection.
- Deep tissue infection (cellulitis). Rarely, swimmer’s ear may result in the spread of infection into deep layers and connective tissues of the skin.
- Bone and cartilage damage (necrotizing otitis externa). An outer ear infection that spreads can cause inflammation and damage to the skin and cartilage of the outer ear and bones of the lower part of the skull, causing increasingly severe pain. Older adults, people with diabetes or people with weakened immune systems are at increased risk of this complication. Necrotizing otitis externa is also known as malignant otitis externa, but it’s not a cancer.
- More widespread infection. If swimmer’s ear develops into necrotizing otitis externa, the infection may spread and affect other parts of your body, such as the brain or nearby nerves. This rare complication can be life-threatening.
- Brain Abscess. A brain abscess forms when fungi, viruses, or bacteria reach your brain through a wound in your head or an infection somewhere else in your body. According to the Children’s Hospital of Wisconsin, infections from other parts of the body account for between 20 and 50 percent of all brain abscess cases. Heart and lung infections are among the most common causes of brain abscesses. However, brain abscesses can also begin from an ear or sinus infection, or even an abscessed tooth.
Your Ears’ Natural Defenses
Your outer ear canals have natural defenses that help keep them clean and prevent infection. Glands that secrete a waxy substance (cerumen). These secretions form a thin, water-repellent film on the skin inside your ear. Cerumen is also slightly acidic, which helps further discourage bacterial growth. In addition, cerumen collects dirt, dead skin cells and other debris and helps move these particles out of your ear. The waxy clump that results is the familiar earwax you find at the opening of your ear canal.
Downward slope of your ear canal. Your ear canal slopes down slightly from your middle ear to your outer ear, helping water drain out.
How the Infection Occurs
If you have swimmer’s ear, your natural defenses have been overwhelmed. Conditions that can weaken your ear’s defenses and promote bacterial growth include:
- Excess moisture in your ear. Heavy perspiration, prolonged humid weather or water that remains in your ear after swimming or showering can create a favorable environment for bacteria
- Scratches or abrasions in your ear canal. Cleaning your ear with a cotton swab or hairpin, scratching inside your ear with a finger, or wearing headphones or hearing aids can cause small breaks in the skin that allow bacteria to grow
- Sensitivity reactions. Hair products or jewelry can cause allergies and skin conditions that promote infection.
Follow these tips to avoid swimmer’s ear:
- Keep your ears dry. Dry your ears thoroughly after exposure to moisture from swimming or bathing. Dry only your outer ear, wiping it slowly and gently with a soft towel or cloth. Tip your head to the side to help water drain from your ear canal. You can dry your ears with a blow dryer if you put it on the lowest setting and hold it at least a foot (about 0.3 meters) away from the ear.
- At-home preventive treatment. If you know you don’t have a punctured eardrum, you can use homemade preventive ear drops before and after swimming. A mixture of 1 part white vinegar to 1 part rubbing alcohol may help promote drying and prevent the growth of bacteria and fungi that can cause swimmer’s ear. Pour 1 teaspoon (about 5 milliliters) of the solution into each ear and let it drain back out. Similar over-the-counter solutions may be available at your drugstore.
- Swim wisely. Watch for signs alerting swimmers to high bacterial counts and don’t swim on those days.
- Avoid putting foreign objects in your ear. Never attempt to scratch an itch or dig out earwax with items such as a cotton swab, paper clip or hairpin. Using these items can pack material deeper into your ear canal, irritate the thin skin inside your ear or break the skin.
- Protect your ears from irritants. Put cotton balls in your ears while applying products such as hair sprays and hair dyes.
- Use caution after an ear infection or surgery. If you’ve recently had an ear infection or ear surgery, talk to your doctor before you go swimming.
Cleaning your outer ear canal is necessary to help ear drops flow to all infected areas. Your doctor will use a suction device or ear curette to clean away any discharge, clumps of earwax, flaky skin and other debris.
Medications for Infection
For most cases of swimmer’s ear, your doctor will prescribe ear drops that have some combination of the following ingredients, depending on the type and seriousness of your infection:
- Acidic solution to help restore your ear’s normal antibacterial environment
- Steroid to reduce inflammation
- Antibiotic to fight bacteria
- Antifungal medication to fight an infection caused by a fungus
Ask your doctor about the best method for taking your ear drops. Some ideas that may help you use ear drops include the following:
- Reduce the discomfort of cool drops by holding the bottle in your hand for a few minutes to bring the temperature of the drops closer to body temperature.
- Lie on your side with your infected ear up for a few minutes to help medication travel through the full length of your ear canal. If possible, have someone help you put the drops in your ear.
- If your ear canal is completely blocked by swelling, inflammation or excess discharge, your doctor may insert a wick made of cotton or gauze to promote drainage and help draw medication into your ear canal.
- If your infection is more advanced or doesn’t respond to treatment with eardrops, your doctor may prescribe oral antibiotics.
Medications for Pain
Your doctor may recommend easing the discomfort of swimmer’s ear with over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others) or acetaminophen (Tylenol, others). If your pain is severe or your swimmer’s ear is at a more advanced stage, your doctor may prescribe a stronger medication for pain relief.
Helping your Treatment Work
During treatment, the following steps will help keep your ears dry and avoid further irritation:
- Don’t swim or scuba dive
- Avoid flying
- Don’t wear an earplug, hearing aid or headphones before pain or discharge has stopped
- Avoid getting water in your ear canal when bathing. Use a cotton ball coated with petroleum jelly to protect your ear during a bath.